Starting Solids: Nutrient Dense Real Food for Babies

Are you a mama or parent who’s a fan of real food?

Is your baby nearing the age where you’re thinking about starting solids?

Are you wondering what the best first foods for baby might be?

Do you question the norm of starting solids with rice cereal and instead want to try nutrient dense, real food for baby?

Great! This super detailed (and hopefully not-too-research-y) post is for you.

Starting Solids: Nutrient Dense Real Food for Babies

Ever since I released Real Food for Pregnancy, I’ve been asked about my thoughts on the best approach for starting solids.

Let me start by saying I do not believe there is a single best approach for starting solids with babies.

Just like everything in parenting, people tend to become very dogmatic about what will/should work for all babies.

Spoiler: There is no ONE best approach that will work for all babies and all families.

As I write this post, my second is nearing the age where we will be starting solids, so this topic is certainly relevant for me. I’ll be sharing about my experience with introducing solid foods with my son, what I learned, and what I plan to do this round.

Notice I say “what I plan to do this round” rather than “what I’m going to do.”

Like all things in parenting, we need to read our babies and adjust our approach for the child in front of us, NOT the unicorn baby described in a baby book. I’m gonna go out on a limb here and say that my plans will probably, somehow, inevitably get thrown for a loop.

TL/DR: Take everything you read here with a grain of salt!

Timing of Starting Solids with Babies

The official recommended age for introducing solid foods varies based on the source. Some say 4 months, but most say 6 months. A comprehensive 2019 review on the timing of introduction of solid foods reaffirmed that 6 months is ideal. I also personally aim for 6 months.

The rationale is that babies should be getting all of their nutrition from breast milk (or formula, if breast milk is not available) early in life. Breast milk is the most nutrient-dense source of nutrition for a baby, providing all macronutrient, micronutrient, and fluid/electrolyte needs in a one stop shop.

Until approximately 6 months of age, their digestive system isn’t well suited to break down solids. Their microbiome needs time to get established first. This is not only key for long term digestive health, but also the health of their immune system as a whole (most of the immune system is located in the gut).

Breast milk is also free of pathogens, whereas solid foods introduce the possibility of food borne illness. Infants who start solids at 6 months versus earlier (such as 3 or 4 months) have significantly lower rates of gastrointestinal infections.

Another reason waiting until 6 months is recommended is that it often (though not always) coincides with a time when baby requires higher amounts of some nutrients for optimal growth, meaning they nutritionally would benefit from breast milk AND some solids. The two major nutrients in question are iron and zinc (more on this later).

Look for Signs of Readiness, Not Just Age

A lot of people get really hung up on the exact age when baby should be eating solids, but you want to introduce solid foods when your baby is ready for them, not when a book tells you.

When you’re in the ballpark of 6-ish months, look for “signs of readiness.” These are signs that your baby is developmentally ready and able to safely start solids.

Typical signs of readiness for starting solid foods are when baby is:

• Sitting up well without support or with minimal support
• Ready to chew (you may notice them “teething” on toys or hands/fingers; no, they don’t need to have any teeth before you begin solids)
• Starting to use a “pincer” grasp with toys/objects (this is when they pick up objects between thumb and forefinger, like you would do when zipping up a zipper) 
• Showing interest in meals (such as trying to grab food from your plate) 

This is not just conjecture, but backed by science:

“The key signals that caregivers should pay attention to are the infant’s ability to sit with little or no help; to munch/chew and swallow soft, solid foods; to have lost the extrusion reflex (the projection of food from the mouth); and to demonstrate interest in food. Achieving these developmental milestones strongly correlates with the maturation of the gastrointestinal tract, kidneys, and immune system required to benefit from introducing complementary foods.” — Advances in Nutrition, 2019

There is no single “Best First Food”

Some parents can get rather obsessive about needing to start with THE perfect first food. The way I hear people talk about it is so stressful, like if you choose the wrong thing, your baby will develop terrible eating habits for life or have an allergic reaction or become malnourished or, or, or…

STOP.

Think First FOODS Instead.

This might surprise you, but I don’t even remember the first food I gave my son. And that was only ~3 years ago. It was either a blackberry he grabbed off the bush when I wasn’t looking or a bite of salmon from our dinner. Or maybe it was egg yolk? Or was it liver pate? Seriously. I don’t know.

And now as an older toddler, he pretty much eats #allthethings.

That doesn’t mean I didn’t give any thought into what his first foods would be. I definitely wanted to introduce nutrient-dense, real food to him as a baby. And you want to be sure the items you offer are a safe size/shape/texture for baby, but you don’t need to stress so much about THE perfect first bite.

Scroll down for more info on what foods/nutrients/flavors I was interested in introducing early and which ones I put less emphasis on.

Baby-Led Weaning vs. Purees

The second question that comes up frequently is whether or not you should do standard weaning or baby-led weaning.

Standard weaning means starting with purees, which are spoon-fed by the parent/care provider. Some also call this “parent-led weaning” or “traditional weaning.” First foods when following this approach could be infant rice cereal, which is a common recommendation from pediatricians, or it could be other pureed baby food (homemade or store-bought).

Baby-led weaning, commonly referred to with the acronym BLW, is when babies are offered developmentally appropriate table foods right from the start of solids. In BLW, infants pick up and self-feed. The BLW movement started gaining traction in the early 2000’s and has now become quite common as an alternative to traditional weaning.

With definitions aside, I want to again reiterate that I do not think there is one right way to introduce foods to your baby.

A note on infant rice cereal

If you opt for standard weaning, I would urge you to consider using whole food purees instead of rice cereal (or other infant cereals, like baby oatmeal). The rationale for using rice cereal is that it is fortified with iron and is an unlikely allergen. That’s it.

Guess what? A whole food source of iron that is also unlikely to be allergenic exists: MEAT.

The heme iron in meat is also far better absorbed and easier on the gut than the ferrous fumarate used in most commercial cereals. Plus, meat also provides zinc, vitamin B12, vitamin B6, vitamin A, and numerous other nutrients that work in synergy to promote baby’s growth.

The guidelines for starting solids in many countries encourage meat as THE first food. We even got a pamphlet in the mail from our state that listed puree meat above iron-fortified infant cereal. Hooray for real food making a comeback!

Now, back to the BLW debate…

Why I’m Not a BLW Purist

When I started solids with my son, I was pretty gung-ho about choosing baby led weaning. I liked the fact that I could offer table foods (aka real food) and give him autonomy over his eating habits, which seemed like it would promote more mindful eating behaviors long term.

For many reasons, I still like BLW and we will be doing a good amount of this method with our daughter when we start solids in the near future.

However, we ultimately found that doing strict BLW 100% of the time did not work for our family. In the end, we probably did about 80-90% BLW and 10-20% purees. 

Why we didn’t do strict BLW

First of all, my son’s personality is part of it. He is very meticulous. He does NOT like making a mess with his food. I have a total of one photo of him with food smeared all over his face from his entire life (he’s almost 4 at the time of writing). At his 1 year birthday party, he picked off individual berries from his banana bread birthday cake and ate them one by one. No smashing. No mess.

To this day, he does not like having dirty hands, having food on his face, or having either his hands or face wiped down (though, as an older toddler, he now enjoys using his utensils and using a napkin to wipe his hands/face after meals). He especially did not like baths. It was not a matter of lacking the motor control or pincer grasp to feed himself; he was well ahead on those milestones. He just didn’t like the mess! And no, he doesn’t have a sensory processing issue of any kind; it’s just his personality. 

So was it worth it for me to force him to self-feed messy foods and then force a bath multiple times a day? HELL NO.

As a parent, you have to parent the child in front of you, not the imaginary one described in a baby book and you have to make the most practical choice for your family. We still did a significant amount of baby led weaning, but ultimately, we also incorporated some purees, especially for really messy foods, specific nutrient-dense foods, and some that he just wasn’t ready to self-feed (but that I wanted to incorporate, like soups made with bone broth).

I’ve seen some ranty posts from BLW experts suggesting that unless you’re doing 100% baby led weaning, then it “doesn’t count” and you shouldn’t call it BLW. All I can say is… way to be supportive! (sarcasm)

Honestly, call it whatever you want. I do like the fact that BLW helped him further develop self efficacy, motor skills, etc… but there are other ways to develop those skills beyond self-feeding (hello: toys, free movement time on the floor, etc.).

The other thing that bugged me about BLW was that it can be restrictive in terms of the items you can safely offer to a young infant. I really wanted to offer as much variety as possible (especially in terms of flavors/nutrient sources), but you’re much more limited when you have to consider the texture (how long to cook it), the shape of the object, etc. This gets easier as the baby gets older and you can offer small cubes of food, but in the beginning, it can be cumbersome. 

Again, this is just personal preference and what I mentally had the bandwidth to do at the time. Some people feel the opposite about BLW and there’s room for ALL WAYS OF INTRODUCING SOLIDS TO BABIES.

By incorporating some purees and some spoon feeding, I was able to offer a wider array of vegetables, liver pate, homemade custard, curries, and so much more. Often, when we’d make a large batch of something at dinner, I’d set aside a ½ cup portion and puree with an immersion blender, then freeze any leftovers into ice cube trays (labelled so I could remember what I made). Or sometimes, I’d just mash it with my fork at the table. This made it ridiculously easy to cobble together a “baby meal” on days when our meals were not 100% baby-friendly textures or flavors (for example, we learned that he does not like spicy foods and still does not to this day).

It was also helpful to have purees as an option when we had a babysitter over. I could defrost several “baby food ice cubes” instead of worry that the sitter might not know the signs of gagging vs. choking, or give the wrong foods, etc.

It just made life easier to have purees as an option. For example, if I had some roasted sweet potato “fries” and avocado as finger foods, I could “round out” the meal with a few bites of liver pate or some slow cooked meat that I had smashed up with my fork so we checked the box for protein and iron.

Store-bought purees: We also kept Serenity Kids pouches on hand. These are shelf-stable and made with grass-fed/pasture-raised meats, good quality fats (avocado or olive oil), and vegetables, so they check all the boxes for a nutritionally complete option for babies. I would keep 1-2 in the diaper bag at any time in case I did not or could not bring a homemade option. Check them out there and save on your first order with code LILY15 *affiliatelink) They also have puffs made with high-quality ingredients that are super convenient for travel or car rides.

Honestly, starting solids is really about finding a method that works for your family and is nutritionally sound.

What the Research Says About Baby Led Weaning

What I’ve written so far is 100% my opinion based on my experience with my son. In other words, this is my anecdotal n=1. Your experience may be entirely different.

So, I dug into the research a bit on baby led weaning to see what the science says from a much larger pool of infants and parents. I also reviewed the original book and cookbook on BLW written by Gill Rapley, so I could cross check whether the science supports the claims in the book.

Baby led weaning is championed as a better approach for introducing solids, but is it really?

Cross-sectional surveys from the UK and New Zealand have found that when compared to parent-led weaning, BLW is associated with less fussiness around food and better satiety regulation, just as the original baby led weaning book claims. However, as of 2020, there’s only one randomised control trial on BLW, which did not find any significant differences between BLW and control groups. Now, some BLW experts have qualms with this study, but no study is perfect.

It’s been suggested that eating behaviors in children, including satiety responsiveness and self-regulation, are probably related more to parental traits and feeding style rather than a matter of BLW vs. purees. In other words, parents who opt for BLW probably also parent differently and themselves have a less controlling relationship with food.

This hypothesis was reaffirmed in a 2019 study which sought to provide “an estimation of the size of the difference between the solid feeding practices groups for a variety of practices consistent with the development of healthy food preferences and behaviours.” In essence, they wanted to quantify just how much better BLW was when compared to parent-led weaning. Below is more information on that study.

A total of 565 participants with infants aged 12-36 months old completed a survey on parental feeding styles, parental feeding practices, sources of information on feeding and toddler’s eating behaviour. Participants were categorised into four groups reflecting the level of infant self-feeding at 1 month after the introduction of solid food: 

• Strict parent-led weaning
• Predominant parent-led weaning
• Predominant BLW
• Strict BLW
  

They explain the groupings as follows:

“To categorise weaning styles, participants were not asked directly whether they followed PLW or BLW practices, removing the potential for differences in interpretation. Instead, using a sliding scale from 0% of the time to 100% of the time, they estimated the portion of time their child fed themselves at one month after the introduction of solid foods. Participants were subsequently grouped into four categories; strict BLW (self-feeding 90% or more of the time); predominant BLW (self-feeding between 51% and 90% of the time); predominant PLW (self-feeding between 10% and 50% of the time) and strict PLW (self-feeding less than 10% of the time).”

Participants were split fairly evenly between the four groups. By grouping in this way, the researchers sought to look at “the whole spectrum of complementary feeding methods, from strict BLW to strict PLW, to allow a more inclusive categorisation than previous studies that focused largely on strict BLW.”

In my opinion, this also is a better representation of real life, as most parents that I know who followed BLW did not do it 100% of the time.

Overall, this study found that strict BLW is linked to:

• Parents exerting significantly less control over their toddler’s eating (including less encouragement in order to increase food consumption)
• More shared mealtimes (including more times eating the same meal with their children)
• Later introduction of solid foods compared to all other groups
• Greater likelihood of offering foods other than baby cereal as a first food
• Infants receiving more flavor variety, vegetables, and mixed meals
• Significantly lower level of food fussiness and more food enjoyment for the toddlers who were allowed to self-feed most of the time in comparison to mainly spoon fed toddlers

This is all very promising, however the study authors caution:

“When it comes to toddlers’ eating behaviour and the family food environment, although some differences were statistically significant, the effect sizes were very small. Considering the long-lasting impact of food preferences developed at this stage along with the stress surrounding infant feeding decisions, it is crucial that the complementary feeding advice parents receive reflects realistic expectations of the outcomes regarding the effects on eating behaviour.”

Moreover, many of the claimed benefits of BLW seem to reflect parenting styles:

“We revealed that mothers who are following a BLW approach are not only less controlling around feeding, but also used significantly less instrumental and emotional feeding. These behaviours are in line with a more responsive pattern of feeding that promotes reliance on internal cues (e.g. hunger) than external cues (e.g. eating as a response to an emotion or a reward) for appetite control. Previous studies have demonstrated that adopting some of the characteristics of parents following a, typically less responsive, PLW approach, such as feeding children in the absence of hunger, in response to specific emotions and encouraging them to consume larger amounts of food than desired, can jeopardize appetite regulation by teaching the child to ignore internal signs of satiety in the presence of food or in response to specific emotions.”

All this to say that YES, baby led weaning is linked to benefits, however many of these benefits are probably a reflection of the parents that naturally choose baby led weaning. This is a really tricky confounding variable to tease out without more randomized controlled trials where parents are randomly assigned to different methods of introducing solids to baby.

One of the big misconceptions I see in the baby feeding world is that spoon feeding is equated with force feeding.

Repeat after me: Spoon Feeding Doesn’t Necessarily Mean Force Feeding

You can still take a responsive feeding approach to introducing solids if you’re spoon feeding. This can be more challenging for some people, however, because you really need to have your undivided attention on your baby to watch for signs of hunger/fullness, enjoyment, etc. when offering bites of food. This is probably why so many parents who are on baby #2, 3, 4 and beyond move more in the direction of baby led weaning. There simply isn’t TIME to sit with baby and spoon feed every bite!

You can also take a mixed approach if you’re offering foods on a spoon. For example, thicker purees can stick to a spoon (think: pate), which you can then offer to baby to self-feed.

Is Baby Led Weaning Better at Meeting the Nutritional Needs of Baby?

There has been mixed evidence on whether BLW might present nutritional advantages or challenges for babies. One cross sectional study found that iron intake among BLW infants was less than half the level compared to babies who were fed purees. 

However, the only randomized controlled trial of BLW vs. purees looking at risk factors for low iron intake found no difference between anemia or markers of iron stores between the two groups (of note, the BLW group had received education around iron-rich foods).

In the survey study I highlighted earlier in this article, I found it worrisome that the first food offered to babies was very rarely meat in any of the groups, whether parent-led or baby-led weaning. It was most commonly vegetables and fruit in the BLW groups (the parent-led weaning group most often started with infant cereal). If we’re concerned about iron intake in infants, this is an area for improvement among BLW education for sure.

Other research has suggested that BLW might not be ideal for families who do not otherwise have well-balanced nutrition. This is a no-brainer. 

If the family is eating boxed mac & cheese, then baby will eat boxed mac & cheese, right? In this situation, it would probably be nutritionally better for baby to have purees (and if there’s no time to make homemade, a store bought puree would make sense for this family). Like all things, context matters. Table foods are only healthier for baby if the foods served at the table are healthy to begin with.  

Research reiterates this concern:

“It has been argued that the reliance on BLW may expose infants to higher levels of fat, sugar and salt and lower levels of vitamins and minerals than those in typically prepared infant foods if the family diet is not well balanced, although the evidence is still mostly conflicting.” — Appetite, 2019

Flavor Window

On the plus side, the higher introduction to vegetables and diverse flavors in those who follow BLW bodes well for children’s taste preferences long term. That’s because research has shown that there’s a critical window of flavor acceptance between 5-7 months of age.

Overall, although preference for sweet and salty is higher than sour and bitter during the first year, research notes that between 5-7 months, babies will equally accept sweet, salty, umami, sour and bitter tastes. 

This means, regardless of feeding choices (BLW vs. purees), you really want to introduce complex flavors early in life, such as bitter (think green vegetables) and sour (think lemon, raspberries, fermented foods, etc.).

This is confirmed in studies that show vegetable introduction in the early weaning period correlate with higher vegetable consumption later in childhood.

Texture Window

Similarly, introducing a variety of food textures is beneficial. Research shows that including complex textures in baby’s diet (at around 10 months of age at minimum) is linked to greater acceptance of different textures of food later on and less likelihood of food fussiness or other feeding problems later in childhood.

BLW builds in many textures by default. This is a definite win. If you’re opting for purees, you want to be sure to advance the texture of the foods offered over time. By 10-11 months of age, it doesn’t really matter how you introduced the first bites of food. All babies at that age should be getting age-appropriate finger foods and complex textures.

There is no right/wrong way for starting solids. BLW isn’t better; it’s an option

When I first posted on Instagram that I would be writing this post, readers sent in questions (many of which are addressed later in this post). My heart sunk when someone wrote “Will I ruin baby’s eating habits if I start with (homemade) purees rather than BLW?” The answer to that is a hard NO. 

Suffice to say, #youdoyou when it comes to introducing solid foods to your baby. The research is still mixed and ultimately, it comes down to personal preference.

There’s one common thread, though…

Virtually all research highlights the importance of responsive feeding. This means observing and responding to baby’s cues when eating. Responsive feeding is definitely possible with purees and it’s essentially built-in with baby led weaning.

Regardless of your final choices, the below considerations on first foods will help you when choosing how to start solids with your baby from a real food perspective.

Considerations When Choosing the Best First Foods for Baby

1. Appropriate shape/size and texture for baby (safety first)

With baby-led weaning, you want to start with foods that are approximately the size/shape of an adult finger, so baby can easily pick up the food and bring to their mouth. 

Think:

• a strip of steak (cut with the grain; baby will gum and suck the juice out but won’t be able to get a chunk of actual meat off)
• a soft-cooked broccoli floret
• a spear of cooked asparagus
• a slice of avocado (leaving a chunk of skin on helps them grasp it)

Offer foods that are cooked soft enough that you can smush it against the roof of your mouth (an indication that baby will be able to use their gums to safely consume it). 

You can also offer firm finger-shaped foods that baby can grasp and teethe/suck/gum on (i.e. a slice of raw bell pepper). These foods are more about flavor exposure and the motor skills aspect than nutrition.

As they get older and their pincer grasp improves, you can slowly decrease the size of the food morsels to smaller bites.

If choosing purees, the main safety concern is to avoid very sticky purees (think nut butters), which can pose a choking hazard. I’d highly recommend a meat-based puree to provide iron. Thin to the appropriate texture with breast milk, formula, or water.

2. Nutrient-dense

As mentioned earlier, the two nutritional advantages of starting solids around 6 months are to provide additional iron and zinc. These are best provided by meat.

One of my favorite first foods for baby is liver pate. For a baby brand new to food, I do a variation on my grass-fed beef liver pate with just liver, coconut oil, a tiny pinch of sea salt, and water or breast milk (you could also just do cooked pureed liver if you prefer). This is off-the-charts high in both iron and zinc as well as choline, B12, folate, selenium, and so much more.

Make a batch once, freeze into ice cube trays, then offer 1-2 cubes of liver pate over the course of the week. It’s an easy peasy way to meet many nutritional needs of baby. 

If you opt for BLW, you could probably do soft-cooked chunks of chicken liver. Personally, I opted for the pate route. You can offer a small bite on a spoon for baby to self-feed or you can spoon feed them yourself.

Another extremely iron-rich and zinc-rich option is canned oysters. They are a soft texture perfect for baby. Since shellfish is a common allergen, I personally wait until I have introduced some other foods first before adding this (more on allergies below). Crown Prince has one version that is canned in olive oil. 

3. Variety of Flavors 

One of my personal goals with introducing solids is to expose baby to as many flavors in the first year as I can. I think many people try to push quantity instead, but we have to remember that baby will still be getting the majority of their nutrition and calories from breast milk (or formula). Plus, their tummies are tiny!

With that said, if all is going well with solid food introduction (meaning no adverse reactions with baby), I personally opt for introducing a new food every day instead of the other common practice, which is to wait 3-4 days between introducing new foods. This is in line with BLW recommendations. If in doubt, ask for your healthcare providers recommendations. I wish I could offer more evidence-based guidance here, but I was unable to find studies on the ideal time to wait between introducing new foods.

My rationale for one food a day is that the more flavors introduced at a young age, the greater the chance that the child will accept a variety of flavors later in life (see research above on the flavor window). You’ll still probably run into picky eating phases in toddlerhood, but as they outgrow those, you’ll have a more adventurous eater on your hand. I’ve seen this firsthand with my son (see this post on real food for toddlers).

For this reason, I tend to lead with pretty complex flavors and disagree with the notion that babies should have bland foods. For example, with my son, I introduced liver pate, a variety of curries (Indian, Thai, etc.), bitter vegetables (cooked, pureed greens as well as finger foods, like cooked broccoli raab and even raw kale stems to teethe on), sour flavors (like grapefruit or plain yogurt), seafood (both fish and shellfish), non-sweet vegetables (i.e. asparagus vs. sweet potato), etc.

Research affirms that starting with vegetables is linked to greater acceptance of vegetables later on: 

“These findings confirm that at the first exposure fruit acceptance is higher than vegetable acceptance. Weaning with vegetables, but not with fruits, may promote vegetable acceptance in infants.” (Food Quality & Preference, 2013)

I personally DO NOT push a lot of fruit to young babies. They’re getting plenty of sweet exposure via breast milk and will naturally always love fruit. You don’t have to try to get your kids to eat enough carbs, believe me. My goal is to introduce the challenging flavors first. 

4. Let Baby Lead: Responsive Feeding

Some people think that if you don’t opt for baby led weaning, then baby doesn’t get a say in what/how they eat. I disagree. It’s very much possible to honor/respond to your baby’s cues, as previously discussed.

Whether you opt for baby led weaning or purees, choose responsive feeding. Do not try to coax the spoon into your baby’s mouth. 

For example, when we offered purees/soup or any items by a utensil to my son, he would show me he was ready by leaning forward with his mouth open. When he got older and could use baby sign language, he could also sign for “more.” We would also verbally ask “do you want more?” before offering another bite.

Even with BLW, we noticed that he didn’t like having too many items on his plate at once, so we responded by offering fewer items at first and providing seconds if/when he showed interest. All kids are different!

5. Allergens

The official recommendations on introducing potentially allergenic foods to baby has done a complete 180 in the past 15 or so years.

Previously, it was recommended that infants avoid common allergens, like milk, egg, and peanut until they reached a certain age (worldwide, this ranged from allergen avoidance for 1-3 years of age).

However, following new research showing that early allergen exposure might actually be protective against food allergies, these recommendations were revised.  

Researchers explain:

“Avoidance of a specific food (such as egg or peanut) does not provide the child with the usual gastrointestinal exposure for achieving oral tolerance and thus may increase the risk of food allergy, regardless of whether the infant is still exposed to food allergen(s) in the environment and is sensitized via the skin.” — Annals of Allergy, Asthma & Immunology, 2019

There is still a lot of debate on the optimal timing of allergen exposure for babies. We have the MOST data on eggs and peanuts in particular whereas data for all other allergens is significantly lacking.

Peanuts
With peanuts, some allergists are suggesting exposure as early as 4 months, while others suggest waiting until at least 6 months as you would with all solids.

In the LEAP study, for example, 640 infants aged 4-10 months old with severe eczema, egg allergy, or both were studied in regards to peanut allergy. The infants were assigned to consume or avoid peanuts until 5 years of age. This study found that among the infants who initially had negative results on the skin prick test (530 infants in total), the rates of peanut allergy at 5 years of age was 13.7% in the group that avoided peanut exposure but only 1.9% in the group that consumed peanuts in infancy.

In other words, early peanut exposure was associated with a significantly lower risk of peanut allergy. This finding has been confirmed in numerous studies as well as systematic reviews of clinical trials. 

Eggs
Similar data exists for eggs; most studies support early introduction of eggs. However the type of egg that is used for exposure differs significantly in studies. For example, some studies use raw egg protein, which is much more allergenic than cooked egg protein. Moreover, most parents are not introducing raw eggs to babies, but instead introducing cooked eggs.

What I found interesting from these studies was that the amount of egg required to “count” as an exposure was surprisingly tiny—as little as 2 grams! For reference a “large” egg weighs 50 grams.

Since the greater the serving size, the greater the allergen exposure, and the higher likelihood of a reaction, it seems wise to introduce a small amount of egg to baby for the first few times. The yolk is also less allergenic than the white, so it makes sense to start with egg yolk only, though this is still up for debate in the research.

Other Allergens
The top 8 allergens are:

• Eggs
• Peanuts
• Milk
• Tree nuts (such as almonds, cashews, walnuts)
• Fish (such as bass, cod, flounder)
• Shellfish (such as crab, lobster, shrimp)
• Soy
• Wheat

These account for an estimated 90 percent of allergic reactions. To date, research on early introduction of allergens beyond eggs and peanuts is lacking. 

One of the few high quality studies we have on the topic is the EAT study. This study looked at early introduction of 6 allergenic foods into the diets of breastfed infants starting with yogurt at age 3 months. By 5 months of age, they introduced sesame, fish, wheat, peanut, and egg.

Ultimately, no benefit was seen for milk, sesame, wheat, or fish. They did, however, show that peanut and egg introduction early on was linked to a lower risk of allergies.

Research is Ongoing with Food Allergen Introduction for Babies

Ultimately, research is ongoing in this area, so I won’t be surprised if the recommendations evolve over time. 

I think this summary from a food allergy researcher says it best:

“The“optimal” window for introduction of complementary foods for allergy prevention remains highly debated. However, to start complementary foods before 3 to 4 months of age may increase the risk of allergic disease. At that age, the gut is more permeable, and gastrointestinal colonization is not yet well established. Consequently, many international infant feeding guidelines for allergy prevention recommend introduction of any solid food after 4 months of age. In addition, the current recommendation should take into account other pivotal aspects such as the infant’s developmental readiness, nutritional needs, parental opinion/needs, and the risk for developing very selective eating habits. In summary, there are still many open issues to be clarified (eg, age of introduction, type of population, type of food, raw or heated allergen, and amount of allergen) before recommendations for food allergy prevention based on introduction earlier than 4 months become applicable for a public health strategy. Based on the current avail-able evidence, we recommend introducing complementary foods from 4 to 6 months of age according to standard local practices and the needs of the infant, irrespective of atopic heredity, until more data on safety and preventive efficacy in introducing before the age of 4 months of age are available. This is the bottom-line common-sense approach suggested by the Australasian Society of Clinical Immunology and Allergy (ASCIA) (“When your infant is ready, introduce foods according to what the family eats, regardless of whether the food is considered to be a common food allergen”), inline with the European Academy of Allergy and Clinical Immunology guidelines.” — Annals of Allergy, Asthma & Immunology, 2019

How We Handled Allergens

When I announced that I would be writing this post, a lot of people asked that I share how we personally handled allergen introduction with my first kiddo. With so much new research on this topic and conflicting opinions from other parents, it’s hard to know what to do.

Disclaimer: I share the following to give you an example of how we handled it, not to say that it’s the “right” or only way. 

With my son, we chose to introduce most allergens between 6-12 months of age. He didn’t have any reactions and does not have any food allergies. Of note, food allergies also do not run in our family and he has a healthy microbiome (vaginal birth, I had no antibiotics in pregnancy/labor, he’s never had antibiotics, exclusive breastfeeding x6 months and continued past 2 years of age).

Eggs: We opted to introduce eggs fairly early, starting with egg yolks, given their incredible nutrient density. We source eggs from pasture-raised chickens. He’s never had a reaction.

Dairy: We opted for yogurt to introduce dairy (as well as butter). Yogurt is fermented and therefore easier on the gut. We later moved on to cheese, then finally milk. Milk did not become a regular part of his diet until we fully weaned from breastfeeding, which was after the age of 2. All of the dairy we consume is full fat, organic, and from grass-fed/pasture-raised cows.

Wheat: We opted for organic whole wheat sourdough that is traditionally fermented (i.e. no added yeast is used) to introduce wheat around 10 months. Traditional fermentation reduces anti-nutrients that irritate the gut, like phytic acid. We personally don’t consume much wheat in our household beyond this, so I don’t recall when he was introduced to other sources of wheat, but he’s never had a reaction to it in any form.

Peanuts: We smeared a tiny bit of creamy organic peanut butter on a piece of banana around 8-10 months (I can’t recall the exact timing). He’s gone through several phases of loving peanut butter and jelly sandwiches and has never had a reaction.

Fish/Shellfish: We opted to introduce fish and shellfish within the first month of starting solids. He had no reaction and he really enjoys his sardines, oysters, salmon, etc. to this day.

For the rest of the allergens, I can’t recall specifically when/how we introduced them, but again, no reactions.

Final Note On Allergens
Remember that exposure to allergens needs to happen several times before you can rule out an adverse reaction. Also remember that the quantity of food required to “count” as an exposure is very tiny. A small bite counts. You don’t have to force feed the baby a whole egg!

For potentially allergenic foods, it’s generally recommended to wait at least 3 days before introducing another potential allergen. If you’re unsure, ask your healthcare professional for their opinion.

Common Questions About Starting Solids with Baby

How much food do I offer? And how often?

At first you only need to offer 1 “meal” a day, which will likely only be a few bites of food (maybe 1-2 Tbsp total). Over time and following their lead, they’ll gradually want to eat larger quantities and to eat more often. Remember to always offer breast milk (or formula) first, as this is still their primary source of nutrition.

What are the best nutrient dense first foods for baby?

I like that you used the words “first foods” over first food. To reiterate some key points, I like to introduce foods that provide ample nutrients for baby’s growing brain (iron and zinc are what’s conventionally considered of greatest importance, but I’m also thinking DHA, choline, B12, etc.). I also want to expose baby to as many complex flavors as possible early on (recall that there’s a key flavor window up to 7 months). I prioritize flavors that most people find challenging, like bitter and sour.

Foods that fit the above profile include: liver pate, ground meat, bone marrow, slow cooked meat, egg yolk, salmon, sardines, canned oysters, bone broth, curries, avocado, non-starchy vegetables (broccoli, asparagus, bell pepper, green bean, etc.), and foods cooked with an array of spices.

What are signs of an allergic reaction?

Symptoms usually start within a few minutes to an hour after eating. If you have any concerns, contact your doctor. If there’s a history of food allergies in your family, I’d talk to your doctor for recommendations on introducing solids.

Mild to moderate symptoms:

• Hives (red welts on the skin)
• A red and itchy rash around the mouth, tongue or eyes
• Mild swelling, particularly of the lips, eyes and face
• Runny nose or sneezing
• Watering eyes
• Nausea and vomiting, tummy cramps
• Diarrhea
• A scratchy or itchy mouth and throat

Severe symptoms (anaphylaxis):

• Wheezing or chest tightness, similar to a severe asthma attack
• Swelling of the tongue and throat, restricting the airways (often observed by noisy breathing or difficulty taking a breath)
• A sudden drop in blood pressure 
• Dizziness, confusion, collapse, loss of consciousness and sometimes coma

I’m afraid of my baby choking. How do I know the difference between gagging and choking?

Honestly, one of the best things you can do is watch YouTube videos of actual babies eating to identify the difference between the two. The gag reflex in babies is much further forward in their mouth than in adults, so you’ll see it relatively frequently as baby learns how to move food around their mouth with their tongue. 

If you observe gagging, the best thing you can do is to let the baby use their tongue (or cough) to move the food forward and out of their mouth. It’s usually loud as they cough and retch to spit out the food. They might turn red, their eyes might water, and you might see their tongue thrusting forward. Whatever you do, don’t stick your finger in baby’s mouth! This makes it much more likely to get lodged in their throat and cause them to actually choke. Gagging is their inborn protective mechanism to prevent choking.

Choking, on the other hand, is when a piece of food has become lodged in their throat and their airway is completely blocked. Baby will be unable to breathe in, unable to vocalize (a good rule of thumb is: if you can hear baby, they’re gagging, not choking!), and possibly start turning blue.

This video from Baby Centre shows gagging:

What do I do if baby is choking?

Gagging happens often, but choking is rare. If baby is indeed choking, you need to intervene immediately. Taking an infant CPR class is always wise. Ask your healthcare professional for recommendations in your area.

Parents Magazine suggests the following (WebMD has similar advice, but this was worded much more clearly, so I’m including their instructions):

“If your child is under a year old:

• Turn your child face down over your forearm or on your lap if you can’t manage the forearm position.
• Hold your child’s jaw with one hand to support the head, which should be lower than the child’s chest.
• Using the heel of your free hand, deliver five quick slaps between the shoulder blades.
• If your child still can’t breathe, try chest thrusts: While holding your baby, turn him or her face-up, keeping their head lower than their chest (not pictured here). Place two fingers in the middle of his or her chest and give five thrusts. Repeat with back blows and chest thrusts until the object is visible and you can remove it.”

This video demonstration might help.

Again, choking is extremely rare, but it’s still important to know how to handle it. We had only one time where I thought my son might be choking (he put two very large blackberries in his mouth at once). Instinct kicks in very quickly and I took him out of the highchair, gave him a swift blow to the back and he was fine.

How do you structure baby meals?

Don’t overthink it. Once I have a good array of food choices introduced into baby’s diet, I just rotate between different protein, veggie/produce, and fat options. Essentially, baby simply gets the same food that we eat at meals unless it’s an inappropriate flavor/texture (the only flavor we avoided was spicy after our son made it clear he didn’t like it!). 

Remember, they start out eating such a small quantity of solid foods. My #1 goals are to regularly offer a source of iron and continue to introduce complex flavors. If I’m serving a fruit or starchy food at the meal, I try to offer the protein + veggie first (more nutrient-dense). If baby is not into those, then I move on to the other easy-sell options (fruit, sweet potato, etc…).

In addition to iron-rich foods, does baby need an iron supplement?

Most likely, no. But you want to take into consideration mom’s health in pregnancy (i.e. was she anemic?) and whether delayed cord clamping was employed at birth. Baby’s iron stores will be reflective of the above two factors.

Research has found that: “the risk of development of iron-deficiency anemia can be greatly reduced, even among those at highest risk (premature and low-birth-weight newborns) through delayed cord clamping, which is a simple and strongly effective intervention that can be readily implemented through proper training of healthcare providers. It is important to acknowledge that iron supplements are recommended for these target vulnerable groups, regardless of age of introduction of complementary foods.” — Advances in Nutrition, 2019

Also, if a family does not include animal foods in their diet (i.e. strict vegans), I’d strongly encourage an iron supplement for baby (as well as B12, DHA, and many other nutrients, but that’s a whole ‘nother post).

Is it true that bone broth helps “seal the gut”?

If you know my work, you know I’m a huge proponent of bone broth generally speaking. But is it going to offer some sort of miraculous fail safe for baby’s gut? Probably not. There is precisely ZERO research on bone broth as the ultimate first food that will seal your baby’s gut. Sorry. It’s just fine as a first food if you want to introduce it, but you’re not doing any harm introducing other foods first.

How often should you keep breastfeeding when starting solids?

Great question! Keep breastfeeding just as you were before. As mentioned earlier, solids are typically started by offering 1 “meal” per day. Solids should be offered after baby has nursed (or if formula feeding, after a bottle). Food is not a replacement for breast milk; it’s in addition to breast milk.

It will take a long time for solid foods to completely replace breast milk. This is why I prefer the terms “complementary foods” or “starting solid foods” over the term “weaning,” which implies that breastfeeding will be ceasing soon.

Can I give baby seasoned food? Do I need to worry about salt or is all the hype around sodium being harmful to babies untrue?

Whew, this question opened up Pandora’s box, so much so that I ended up researching the daylights out of this and I’m currently writing a whole separate post on the messy science of infant sodium recommendations. Stay tuned.

UPDATE: My post on salt and baby food is ready. Read it here: Don’t Add Salt to Baby Food: The Surprisingly Weak Evidence for Infant Sodium Requirements

Is the saying “food before one is just for fun” accurate? I hear this a lot in BLW circles.

Yes and no. I think the intention behind this quote is for parents to not worry if their child is slower to take to solid foods or not interested in eating a large quantity. This I agree with. 

However, solid foods do serve an important role nutritionally. Have the “flavor window” in mind. And seek the help of specialists to rule out any developmental issues if older babies (typically 8m+) are not interested in solid foods at all.

I’d like this saying more if it was revised to “Food before one is also for fun!”

Summary

Starting solids with baby is such a big milestone, so I hope this article helps explain the rationale and caveats behind a lot of the advice you read on the wild wild west of the interwebs.

Remember, the most important concepts to have in mind when starting solids are:

• There’s no right or wrong ways to introduce solid foods
• Watch for signs of developmental readiness for solids, not just baby’s age
• Start with nutrient-dense real foods (especially foods high in iron & zinc)
• Offer a variety of flavors (& textures, when developmentally appropriate)
• And perhaps most important of all is to practice responsive feeding (regardless of if you choose BLW, purees, or a combination)

Before you go, I’d love to hear your thoughts on starting solids with baby.

For those of you with older kids, how did you introduce solids? Purees? Baby led weaning? A combination? What was your experience and how did you choose?

For those with young babies who are planning to introduce solids, what approach are you planning for? How has reading through this article informed your plans?

I’m super curious to read your comments!

Until next time,
Lily

P.S. – Aside from introducing solids, the next most common question I get about food for kids is how to handle toddler eating. If you want some reassurance as your kiddo enters a picky eating phase, check out my post on Real Food for Toddlers.

P.P.S. – Check back in a few weeks for my article on infant sodium/salt needs. The best way to stay in the loop is to join my email list. Visit the freebies page, take your pick, and you’ll also receive my weekly (or, let’s be real, probably every-other-week) email newsletter.

UPDATE: My post on salt and baby food is ready. Read it here: Don’t Add Salt to Baby Food: The Surprisingly Weak Evidence for Infant Sodium Requirements

 

UPDATE: Recommended Baby Feeding Gear

After numerous requests, I’m adding a list to some products that we use and love. Don’t worry, I’m a minimalist and intentionally try not to accumulate lots of baby/kid gear. If you click the link and purchase, I’ll receive a small commission as an Amazon affiliate. The price is the same for you whether you use my link or not. 

Plate — Silicone plates stick to the table, so baby is less likely to create a big mess. Take your pick of a big or small one. We have one of each.
Spoon — The design looks weird, but this silicone spoon is wonderful. It’s a great option for serving pate to babies and letting them self-feed. I love that it makes it easy for baby to start using utensils.
Bucket bib — These are key for catching fallen food, especially while using BLW. Just empty the bib back onto their plate to cut down on food waste. I often layer a cloth bib underneath to keep baby’s onesie dry. Clean up is easy with a quick scrub/rinse (hooray for cutting down on laundry!).
Long sleeved bib — If you’ve got a super messy eater, this is clutch.
Trip Trap high chair — Yeah, these are pricey, but they grow with the child so you never need a booster seat. There’s a reason why they get rave reviews and rarely show up at baby/kid consignment shops (though DO be sure to check for a second hand one first!). I love that older babies can climb in and out of the chair without assistance and that it encourages babies to sit up straight (versus those clunky, semi-reclined high chairs). No fabric means easy cleaning. Our older one still uses his chair and we’ll be transitioning him to a regular chair and letting baby use this one. All we need to do is move the seat back up and reinstall the infant attachments.
Portable high chair — This is pictured in the photo at the top of this post. We got this to have a high chair while traveling and quickly realized it was perfect to attach to our kitchen counter. This makes it super convenient to let baby sit at the counter and teeth on some raw veggie slices or teethers (or eat a snack/meal) while I cook since our dining room is separate from the kitchen.

 

References

1. Burgess, John A., et al. “Age at introduction to complementary solid food and food allergy and sensitization: A systematic review and meta‐analysis.” Clinical & Experimental Allergy 49.6 (2019): 754-769.
2. Pérez-Escamilla, Rafael, et al. “Perspective: Should Exclusive Breastfeeding Still Be Recommended for 6 Months?.” Advances in Nutrition (2019).
3. Brown, A., & Lee, M. (2013). An exploration of experiences of mothers following a baby- led weaning style: Developmental readiness for complementary foods. Maternal and Child Nutrition, 9(2), 233–243.
4. Cameron, S., Taylor, R. W., & Heath, A.-L. M. L. (2013). Parent-led or baby-led? Associations between complementary feeding practices and health-related beha- viours in a survey of New Zealand families. BMJ Open, 3(12), e003946
5. Fu, X., Conlon, C. A., Haszard, J. J., Beck, K. L., von Hurst, P. R., Taylor, R. W., et al. (2018). Food fussiness and early feeding characteristics of infants following Baby-Led Weaning and traditional spoon-feeding in New Zealand: An internet survey. Appetite, 130, 110–116
6. Komninou, Sophia, J. C. G. Halford, and J. A. Harrold. “Differences in parental feeding styles and practices and toddler eating behaviour across complementary feeding methods: Managing expectations through consideration of effect size.” Appetite 137 (2019): 198-206.
7. Rowan, H., & Harris, C. (2012). Baby-led weaning and the family diet. A pilot study. Appetite, 58(3), 1046–1049.
8. Schwartz, C., Issanchou, S., & Nicklaus, S. (2009). Developmental changes in the accep- tance of the five basic tastes in the first year of life. British Journal of Nutrition, 102(9), 1375–1385.
9. Schwartz, C., Chabanet, C., Lange, C., Issanchou, S., & Nicklaus, S. (2011). The role of taste in food acceptance at the beginning of complementary feeding. Physiology & Behavior, 104(4), 646–652.
10. Barends, Coraline, et al. “Effects of repeated exposure to either vegetables or fruits on infant’s vegetable and fruit acceptance at the beginning of weaning.” Food quality and preference 29.2 (2013): 157-165.
11. Muraro, A., et al. “EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy.” Allergy 69.5 (2014): 590-601.
12. Ierodiakonou, Despo, et al. “Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease: a systematic review and meta-analysis.” Jama 316.11 (2016): 1181-1192.
13. Perkin, Michael R., et al. “Randomized trial of introduction of allergenic foods in breast-fed infants.” New England Journal of Medicine 374.18 (2016): 1733-1743.
14. Du Toit G, Roberts G, Sayre PH, et al; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Eng J Med. 2015;372(9):803-813.
15. Du Toit, George, et al. “Effect of avoidance on peanut allergy after early peanut consumption.” New England Journal of Medicine 374.15 (2016): 1435-1443.
16. Muraro, Antonella, and Stefania Arasi. “Solid foods should be introduced into susceptible infants’ diets early in life-CON.” Annals of Allergy, Asthma & Immunology 122.6 (2019): 586-588.
17. Brown A, Jones SW, Rowan H. Baby-led weaning: the evidence to date. Curr Nutr Rep. 2017;6(2):148-156.
18. Rapley G, Forste R, Cameron S, Brown A, Wright C. Baby-led weaning: a new frontier? ICAN: Infant Child Adolesc Nutr. 2015;7(2):77-85.
19. Cameron SL, Heath AL, Taylor RW. Healthcare professionals’ and mothers’ knowledge of, attitudes to, and experiences with, baby-led weaning: a content analysis study. BMJ Open. 2012;2(6):e001542.
20. Rapley G. Baby-led weaning: the theory and evidence behind the approach. J Health Visiting. 2015;3(3):144-151.
21. Cameron SL, Taylor RW, Heath AL. Development and pilot testing of Baby-led Introduction to SolidS—a version of Baby-led Weaning modified to address concerns about iron deficiency, growth faltering, and choking. BMC Pediatr. 2015;15:99.
22. Daniels L, Heath AL, Williams SM, et al. Baby-led Introduction to SolidS (BLISS) study: a randomized controlled trial of a baby-led approach to complementary feeding. BMC Pediatr. 2015;15:179.
23. Brown A, Lee MD. Early influences on child satiety‐responsiveness: the role of weaning style. Pediatr Obes. 2015;10(1):57-66.
24. Taylor RW, Williams SM, Fangupo LJ, et al. Effect of a baby-led approach to complementary feeding on infant growth and overweight: a randomized clinical trial. JAMA Pediatr. 2017;171(9):838-846.
25. Pesch MH, Lumeng JC. Early feeding practices and development of childhood obesity. In: Freemark M, ed. Pediatric Obesity: Etiology, Pathogenesis, and Treatment. 2nd ed. Springer International Publishing AG; 2018:257-270.
26. Arden MA, Abbott RL. Experiences of baby‐led weaning: trust, control, and renegotiation. Matern Child Nutr. 2015;11(4):829-844.
27. Townsend E, Pitchford NJ. Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case–controlled sample. BMJ Open. 2012;2(1):e000298.
28. Erickson LW. A Baby-led approach to complementary feeding: adherence and infant food and nutrient intakes at seven months of age [master’s thesis]. Dunedin, New Zealand: University of Otago; 2015.
29. Jones BL. Making time for family meals: parental influences, home eating environments, barriers, and protective factors. Physiol Behav. 2018;193(pt B):248-251.
30. Fangupo LJ, Heath AM, Williams SM, et al. A baby-led approach to eating solids and risk of choking. Pediatrics. 2016;138(4):e20160772.
31. Morison BJ, Taylor RW, Haszard JJ, et al. How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6-8 months. BMJ Open. 2016;6(5):e010665.
32. Williams Erickson L, Taylor RW, Haszard JJ, et al. Impact of a modified version of baby-led weaning on infant food and nutrient intakes: the BLISS Randomized Controlled Trial. Nutrients. 2018;10(6):e740.
33. Greer FR, Sicherer SH, Burks AW, American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121(1):183-191.
34. Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017;139(1):29-44.