Solids at 4 months

When, What, and How to Introduce Solid Foods | Nutrition

For more information about how to know if your baby is ready to starting eating foods, what first foods to offer, and what to expect, watch these videos from 1,000 Days.

The Dietary Guidelines for Americans and the American Academy of Pediatrics recommend children be introduced to foods other than breast milk or infant formula when they are about 6 months old. Introducing foods before 4 months old is not recommended. Every child is different. How do you know if your child is ready for foods other than breast milk or infant formula? You can look for these signs that your child is developmentally ready.

Your child:

Sits up alone or with support.
Is able to control head and neck.
Opens the mouth when food is offered.
Swallows food rather than pushes it back out onto the chin.
Brings objects to the mouth.
Tries to grasp small objects, such as toys or food.
Transfers food from the front to the back of the tongue to swallow.

What Foods Should I Introduce to My Child First?

The American Academy of Pediatrics says that for most children, you do not need to give foods in a certain order. Your child can begin eating solid foods at about 6 months old. By the time he or she is 7 or 8 months old, your child can eat a variety of foods from different food groups. These foods include infant cereals, meat or other proteins, fruits, vegetables, grains, yogurts and cheeses, and more.

If your child is eating infant cereals, it is important to offer a variety of fortifiedalert icon infant cereals such as oat, barley, and multi-grain instead of only rice cereal. Only providing infant rice cereal is not recommended by the Food and Drug Administration because there is a risk for children to be exposed to arsenic. Visit the U.S. Food & Drug Administrationexternal icon to learn more.

How Should I Introduce My Child to Foods?

Your child needs certain vitamins and minerals to grow healthy and strong.

Now that your child is starting to eat food, be sure to choose foods that give your child all the vitamins and minerals they need.

Click here to learn more about some of these vitamins & minerals.

Let your child try one single-ingredient food at a time at first. This helps you see if your child has any problems with that food, such as food allergies. Wait 3 to 5 days between each new food. Before you know it, your child will be on his or her way to eating and enjoying lots of new foods.

Introduce potentially allergenic foods when other foods are introduced.

Potentially allergenic foods include cow’s milk products, eggs, fish, shellfish, tree nuts, peanuts, wheat, soy, and sesame. Drinking cow’s milk or fortified soy beverages is not recommended until your child is older than 12 months, but other cow’s milk products, such as yogurt, can be introduced before 12 months. If your child has severe eczema and/or egg allergy, talk with your child’s doctor or nurse about when and how to safely introduce foods with peanuts.

How Should I Prepare Food for My Child to Eat?

At first, it’s easier for your child to eat foods that are mashed, pureed, or strained and very smooth in texture. It can take time for your child to adjust to new food textures. Your child might cough, gag, or spit up. As your baby’s oral skills develop, thicker and lumpier foods can be introduced.

Some foods are potential choking hazards, so it is important to feed your child foods that are the right texture for his or her development. To help prevent choking, prepare foods that can be easily dissolved with saliva and do not require chewing. Feed small portions and encourage your baby to eat slowly. Always watch your child while he or she is eating.

Here are some tips for preparing foods:

Mix cereals and mashed cooked grains with breast milk, formula, or water to make it smooth and easy for your baby to swallow.
Mash or puree vegetables, fruits and other foods until they are smooth.
Hard fruits and vegetables, like apples and carrots, usually need to be cooked so they can be easily mashed or pureed.
Cook food until it is soft enough to easily mash with a fork.
Remove all fat, skin, and bones from poultry, meat, and fish, before cooking.
Remove seeds and hard pits from fruit, and then cut the fruit into small pieces.
Cut soft food into small pieces or thin slices.
Cut cylindrical foods like hot dogs, sausage and string cheese into short thin strips instead of round pieces that could get stuck in the airway.
Cut small spherical foods like grapes, cherries, berries and tomatoes into small pieces.
Cook and finely grind or mash whole-grain kernels of wheat, barley, rice, and other grains.

Learn more about potential choking hazards and how to prevent your child from choking.

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When Can My Baby Start Eating Solid Foods? (for Parents)

A friend just started giving her 3-month-old applesauce and rice cereal. My son is just 2 weeks younger than hers, and I am wondering if I should be introducing solids soon too. When should I start?
– Taylor

Doctors recommend waiting until a baby is about 6 months old to start solid foods. Starting before 4 months is not recommended.

At about 6 months, babies need the added nutrition — such as iron and zinc — that solid foods provide. It’s also the right time to introduce your infant to new tastes and textures.

Some babies may be ready for solids sooner than 6 months, but don't start until your baby is at least 4 months old.

How do you know it’s the right time to start solid foods? Here are some signs that babies are ready:

They have good head and neck control and sit up in a high chair.
They're interested in foods. For example, they may watch others eat, reach for food, and open their mouths when food approaches.
They don’t push food out of their mouths, which is a natural tongue reflex that disappears when they’re between 4–6 months old.
They weigh twice their birth weight, or close to it.

Talk to your doctor about the right time to start solid foods.

How Should I Start Solids?

When the time is right, you can start with a single-grain, iron-fortified baby cereal. Start with 1 or 2 tablespoons of cereal mixed with breast milk, formula, or water. Feed your baby with a small baby spoon. Don’t add cereal or other food to a baby's bottle because it can lead to too much weight gain. Let your baby practice eating from a spoon and learn to stop when full.

When your baby gets the hang of eating the first food, introduce others, such as puréed meat, fruits, vegetables, beans, lentils, or yogurt. Try one food at a time and wait a few days before trying something else new to make sure your baby doesn't have an allergic reaction.

Foods that are more likely to cause allergies can be among the foods you introduce to your baby. These include peanuts, eggs, cow’s milk, seafood, nuts, wheat, and soy. Waiting to start these foods does not prevent food allergies. Talk to your doctor if you are concerned about food allergies, especially if any close family members have allergies, food allergies, or allergy-related conditions, like eczema or asthma.

Infants with severe eczema or egg allergies are more likely to have allergies to peanuts. Talk to your doctor about how and when to introduce these foods to your child.

When starting your baby on solids, avoid:

foods with added sugars and no-calorie sweeteners
high-sodium foods
honey, until after the first birthday. It can cause botulism in babies.
unpasteurized juice, milk, yogurt, or cheese
regular cow's milk or soy drinks before 12 months instead of breast milk or formula. It’s OK to offer pasteurized yogurt and cheese.
foods that may cause choking, such as hot dogs, raw carrots, grapes, popcorn, and nuts

Also, do not give fruit juices to infants younger than 12 months old.

Over the next few months, introduce a variety of foods from all the food groups. If your baby doesn't seem to like something, don’t give up. It can take 8 to 10 tries or more before babies learn to like new foods.

Reviewed by: Mary L. Gavin, MD

Date reviewed: February 2021

Russian Union of Pediatricians

Introduction of complementary foods

How to introduce complementary foods correctly is one of the most pressing issues that concern parents.

In the first months of life, the main food for the baby is breast milk or an adapted milk formula, however, as the child grows and develops, this becomes insufficient and it is necessary to think about the introduction of complementary foods.

Your baby is over 4 months old. He has noticeably grown up, become more active, is interested in objects that fall into his field of vision, carefully examines them and reaches for them. The child's emotional reactions have become much richer: he smiles happily at all people, makes various sounds. Perhaps you notice that the child looks into your plate with interest, closely monitors what and how you eat, does this mean that it is time to introduce complementary foods? And where is the best place to start? Let's figure it out!

When should complementary foods be started?

According to the Program for optimizing the feeding of infants in the first year of life in the Russian Federation (2019), the recommended age for the introduction of complementary foods is in the range from 4 to 6 months.

The following points will help determine the readiness of the baby for the introduction of complementary foods:

1. Food interest - you can check its presence as follows: during your meal, give the baby an empty spoon or fork, and if he plays with it, licks it, then there is no food interest yet; but if the child is dissatisfied with the fact that the spoon is empty, food interest has probably appeared. “But how does a child understand that there should be food in a spoon?” Parents often ask. The answer is quite simple: take your baby to the table with you so that he can see how you eat!

2. The child can sit alone or with support. It is unacceptable to feed the child lying down, because he may choke.

3. Extinction of the “pushing out” reflex - when the baby pushes out of the mouth both the offered food and the pacifier, etc.

Why is it not recommended to introduce complementary foods before 4 and after 6 months of life?

Before 4 months of life, the baby is not yet ready to digest food other than breast milk or infant formula. By this age, a number of digestive enzymes mature, a sufficient level of local immunity is formed, which reduces the risk of developing allergic reactions, the child acquires the ability to swallow semi-liquid and thicker food, which is due to the extinction of the “spoon ejection reflex”. The introduction of complementary foods after 6 months can cause a pronounced deficiency of micronutrients (iron, zinc, etc. ) and lead to a delay in the formation of chewing skills for thick foods. Too late the introduction of a variety of products increases the risk of allergic reactions. Remember that the timing of the introduction of complementary foods is set individually, taking into account the readiness of the child to accept new foods.

Complementary feeding guidelines:

1. introduce a new product in the first half of the day to track possible reactions to it;

2. cereals, vegetable / fruit / meat purees should be introduced, starting with monocomponent ones, gradually adding other products of this group;

3. start giving a new product with 1/2 teaspoon, gradually increasing the volume to the age norm within a week;

4. It is not recommended to introduce new products during acute infectious diseases or at some special moments (moving to another apartment, leaving the city, on vacation, illness of parents, etc.).

What is the best way to start complementary foods?

The first complementary food can be anything. Often parents worry that if the child first tries the fruit, then because of its sweet taste, he will refuse other foods. We hasten to reassure you: breast milk is also sweet, so babies may like sweet fruits / berries more, but this does not mean at all that he will refuse vegetables or cereal. Traditionally, they begin to introduce complementary foods in the form of mashed potatoes, but if the child shows interest in “pieces”, then, observing the safety rules, you can give them. Also, along with the introduction of complementary foods, you can offer the child water.

With the start of the introduction of complementary foods, the child is gradually transferred to a 5-time feeding regimen. If the baby shows that he is full and no longer wants to eat (for example, leaning back or turning away from food), then you should not continue to force him to feed, because this can lead to eating disorders in the future. Also, do not force the child to eat as much as possible before bedtime in the hope that he will not wake up for nightly feedings.

Traditionally, in our country, complementary foods begin with vegetables or cereals.

Vegetables: zucchini, broccoli, cauliflower, pumpkin, etc. If the child did not like the dish, for example, broccoli, do not give up on your plan and continue to offer this vegetable in small quantities daily, you can even not once, but 2-3 times, and after a while (7-14 days) the baby will get used to the new taste. This diversifies his diet, will help form the right taste habits in the child.

As for cereals, it is worth starting with dairy-free gluten-free ones - buckwheat, corn, rice. You can use commercial baby food porridge, which is enriched primarily with iron. In addition, such porridge is already ready to eat, you just need to dilute it with water, which will save you a lot of time.

It is also recommended to add oil to food, for example, vegetable puree to vegetable puree, and butter to porridge.

Of meat products, lean meats, such as mashed turkey or rabbit, are most preferred to start complementary foods. Meat puree contains iron, which is easily absorbed, and adding meat to vegetables improves the absorption of this micronutrient from them. Subsequently, the daily use of children's enriched porridge and mashed meat allows you to meet the needs of babies for iron, zinc and other micronutrients.

When introducing fruit purees (apple, pear, peach, prunes, etc.) into your baby's diet, you should pay special attention to the composition of the product - it is important that it does not contain added sugar.

Fish is a source of easily digestible protein and contains a large amount of polyunsaturated fatty acids, including the omega-3 class, as well as vitamins B2, B12, and minerals. Preference should be given to oceanic fish, preferably white (cod, hake, pollock, sea bass, etc.), salmon can be recommended from red, and pike perch from river.

Fermented milk products are prepared using a special starter culture that breaks down milk protein, so that the baby can get an indispensable set of amino acids in a well-available form. Some foods have added prebiotics, certain vitamins and minerals. Their regular use favorably affects the functioning of the intestines, increases appetite and the absorption of micronutrients.

Recommendations and timing of the introduction of complementary foods for children at risk of developing food allergies and suffering from food allergies are the same as for healthy children. Delayed introduction of highly allergenic foods has previously been recommended to prevent the development of allergic diseases in children at risk. There is now evidence that this practice may lead to an increase rather than a decrease in the incidence of food allergies. The most common highly allergenic foods include cow's milk, chicken eggs, soybeans, wheat, peanuts, tree nuts, shellfish and fish. If a child has a high risk of developing allergies or an existing allergic disease, it is recommended to consult a pediatrician, an allergist-immunologist before introducing highly allergenic products.

By the age of 8 months, when all the main food groups have already been introduced and your baby is improving his skills to eat on his own, special attention should be paid to the diversity of the composition of dishes and the change in food consistency - from puree to finely and coarsely ground. Soft foods cut into small pieces (fruits, vegetables, meat, etc.) are perfect for a little gourmet, which diversifies his diet and will contribute to the formation of chewing skills.

By 9-12 months, most babies have the dexterity to drink from a cup (holding with both hands) and to eat foods prepared for other family members. This behavior needs to be encouraged, but combined with regular feeding to meet energy and nutrient requirements.

It is advisable to use industrial products that are designed specifically for young children after a year.

What should not be given to the baby?

It is not recommended to add salt or sugar to food to enhance the taste.

Drinks that should be avoided include fruit juices, whole cow and goat milk (whole milk is not recommended for children under one year old, and even longer, due to a high risk of developing iron deficiency and increased kidney stress), sweet fruit drinks, compotes and carbonated drinks.

Also, some foods should be excluded from the diet of infants: solid round foods (for example, nuts, grapes, raw carrots, raisins, peas, etc.), due to the fact that the child can choke on them.

It is not recommended to eat products with added sugar, for example, confectionery (marshmallow, marshmallow, marmalade, jam, jam, cookies, waffles, etc.), etc.

You should not give your child the meat of large predatory fish (shark, bigeye tuna, king mackerel, swordfish): these types of fish accumulate more harmful substances than others.

It is forbidden to give honey to children under one year old due to the fact that it may contain spores of Clostridium botulinum bacteria, which in the still immature digestive system of babies are able to multiply, produce toxins directly inside the intestines and, thus, cause infant botulism, which can be fatal. outcome.

Do not give babies raw meat, fish, eggs, caviar, salted fish, soft pickled cheeses because of the risk of intestinal infections.

If you follow all these simple rules, your baby will grow up healthy and happy!

Diets for different ages

References:

1. Methodological recommendations. The program for optimizing the feeding of children in the first year of life in the Russian Federation. [Internet]. - M.: Union of Pediatricians of Russia, 2019. [Methodicheskie rekomendaczii. Programma optimizaczii vskarmlivaniya detej pervogo goda zhizni v Rossijskoj Federaczii. [Internet]. – Moscow: Soyuz pediatrov Rossii, 2019.(In Russ.).] Available: http://www.pediatr-russia.ru/information/dokumenty/other-docs/nacprog1year_2019.pdf Link active as of 20.04.2020

2. Duryea T.K. Introducing solid foods and vitamin and mineral supplementation during infancy. In: Post T, ed. UpToDate . Waltham, Mass.: UpToDate; 2020. www.uptodate.com. Accessed April 20, 2020.

3.Fleischer D.M. Introducing highly allergenic foods to infants and children. In: Post T, ed. UpToDate . Waltham, Mass.: UpToDate; 2020. www.uptodate.com. Accessed April 20, 2020.

Symptoms of teething in children under one year old and how to alleviate them

In the first year of life, the child develops rapidly. He learns to sit, crawl, walk. And he also has something that indicates the general physiological development, the maturation of the digestive system. He is preparing to move from eating exclusively milk or formula to a new stage - to the use of semi-solid and solid foods and the appearance of first milk teeth .

The eruption of the first milk teeth is influenced by genetic characteristics, health, nutrition and other factors. Even the dependence of teething in infants on the region of residence has been established. So, in the northern regions of Russia, there is a frequent deviation from the average terms towards a later eruption of ^[1] .

On average, the first baby tooth appears at 6-7 months. Within three years, all 20 milk teeth will take their place in the dentition. In some babies, teething begins at 4-5 months, someone waits up to 10-12 months. All of this is within the normal range of ^[2] .

There are several theories explaining the process of teething ^[2] :

Hunter's theory - pushing the tooth out of the bone alveolus occurs due to the pressure of growing roots;
Yasvoin's theory - the appearance of a tooth above the gum provokes processes of differentiation in the tissue of the dental papilla;
Katz's theory - an increase in tissue pressure in the area of the bottom of the alveoli directs the tooth to the surface.

But none of them can fully explain this complex mechanism.

By the time the tooth erupts, the area of bone covering the crown of the tooth has been resorbed. The same processes are noted in the gum. During the growth of the tooth root, the bone is also rebuilt and the dental alveoli gradually deepen. At the same time, morphological changes in the tissues surrounding the tooth occur: increased blood flow, changes in vascular permeability, increased production of the main substance of the pulp and periodontium
"Can the physiological process of teething in infants be pathological?" Doctor of Medical Sciences, Professor, Chief Pediatrician of the Central Federal District of the Russian Federation, Honored Doctor of the Russian Federation Zakharova I. N. ^[2]

It is not surprising that the appearance of teeth causes discomfort in children at any age, but this process is especially difficult for infants.

Symptoms of teething in a child

The appearance of milk teeth is a natural physiological process, however, a number of children develop a symptom complex, which, according to the International Classification of Diseases, is classified as teething syndrome (ICD code - K00. 7). Numerous surveys of young children say that the most common symptoms accompanying the appearance of teeth are:

increased salivation — processes in the oral cavity are activated;
irritability - the child experiences severe discomfort and cannot report it otherwise than by changing behavior;
sleep disturbance - the pain is so severe that the baby cannot sleep or wakes up frequently during the night;
itching of the gums - children try to compensate for it by trying to bite the breast or nipple, by trying to keep hands, toys, clothes in their mouths.

Such harbingers of the appearance of a tooth occur in 35-60% of children. But some babies may have non-specific symptoms ^[2] :

On average, symptoms appear 5-8 days before the appearance of a tooth. When teething several teeth at the same time, this, as a rule, increases the discomfort.

Even if the child's symptoms are very similar to those of teething, a specialist consultation is necessary. Be sure to consult a doctor if diarrhea or fever persists for a long time.

Ways to alleviate discomfort

To ease teething in a baby, it is necessary:

to provide additional attention and care from parents;
if the child is breastfed, breastfeed more often as this has a slight sedative effect;
purchase several silicone teethers that can be cooled and offered to the baby during the day;
massage the gums with a finger wrapped in a clean gauze pad or with a special silicone nozzle;
blot drool in time with a clean tissue to avoid irritation of the skin around the mouth;
use medicines if necessary and in agreement with the doctor.

Today, there are pharmacological and non-pharmacological methods of therapy for the eruption of temporary teeth.

Topical preparations

Pediatrician prescribes gels and ointments as symptomatic relief for severe discomfort associated with teething.

Such gels and ointments for teething with proven effectiveness are divided into 3 groups ^[1] :

Preparations with analgesic effect based on anesthetic (lidocaine, choline, benzocaine). Sometimes lidocaine-based preparations include anti-inflammatory or antiseptic components, providing a combined effect of the gel.
Medicines based on anti-inflammatory or antiseptic agents.
Preparations based on extracts of medicinal plants. They use extracts of Roman chamomile, boswellia, aloe, marshmallow, Indian ivy, medicinal rhubarb, calendula and other components of plant origin.

Homeopathic teething products are also produced, but their effectiveness has not been scientifically proven ^[1] .

Systemic drugs

In severe pain syndrome, hyperthermia, non-steroidal anti-inflammatory drugs are used, which reduce body temperature and have a systemic analgesic effect. The pediatrician should select the dosage and the drug suitable for the child.

Distractions

These include the gum massage described above and baby teethers that help your baby temporarily relieve gum itching.

Inspection of erupted teeth

Swelling and redness of the gums gradually subside as the infant's teeth erupt and grow, but should be monitored. Normally, the teeth should be evenly located in the dentition, not have whitish or colored spots, irregularities on the enamel.

Violation of the timing, pairing and sequence of eruption of milk teeth can serve as a marker of various diseases and disorders. For example, rickets or hypothyroidism ^[2] . It is important to record the date of appearance of each tooth and its location in the mouth. It is convenient to do this with photos saved in a separate folder on your smartphone.

Erupted Tooth Care Instructions

To clean baby's teeth, use special silicone fingertips with soft bristles. Toothpaste should be labeled as suitable for young children and free of substances that are harmful if swallowed: high concentrations of fluoride, parabens, sodium lauryl sulfate.

As soon as the first tooth shows above the gum line, it needs special care . Enamel has not yet fully formed, it is very thin, so children's caries develops rapidly. Only 10% of children manage to avoid caries and adults practically fail ^[5] . Therefore, do not postpone the preventive fight against it.

To maintain the health of milk teeth, some of which will remain with the child until the age of 10-12, it is important to visit the dentist regularly once every 3-4 months. After a year, you need to visit an orthodontist to make sure that the bite develops correctly.