When to Start Solid Foods in Infants
Solid foods should be introduced around 6 months of age, but not before 4 months, when the infant demonstrates developmental readiness including good head control and the ability to sit with support. 1, 2
Timing Framework
- Standard recommendation: Begin solid food introduction at approximately 6 months of chronological age 1, 2
- Earliest acceptable age: 4 months, but introduction should not occur before this age 1, 2
- Critical window: Do not delay introduction beyond 6 months, as this can lead to inadequate nutrient intake, growth deficits, and feeding problems 2
Developmental Readiness Indicators
Before introducing solids, the infant must demonstrate:
- Good head control - essential for safe eating and swallowing 2
- Ability to sit with support 2
- Loss of tongue-thrust reflex that automatically pushes food out of the mouth 2
Risk-Stratified Approach to Allergenic Foods
High-Risk Infants (Severe Eczema and/or Egg Allergy)
For infants with severe eczema or egg allergy, introduce peanut-containing foods between 4-6 months after evaluation by a specialist, which may include skin prick testing or specific IgE measurement. 1
- Start with other solid foods first to confirm the infant can safely consume solids 1
- Specialist evaluation should occur before peanut introduction in this group 1
- Introduction should occur in a supervised medical setting for those with positive testing 1
Mild-to-Moderate Eczema
- Introduce peanut-containing foods around 6 months at home without specialist evaluation 1
- Other solid foods should be introduced first to demonstrate developmental readiness 1
Standard Risk Infants
- Allergenic foods (peanut, egg, dairy, wheat) can be introduced at the same time as other complementary foods around 6 months 1, 2
- No special precautions or delayed introduction needed 1, 2
Practical Implementation Strategy
Initial Foods
- Start with iron-rich foods including iron-fortified cereals and pureed meats, as these address common nutritional deficiencies 2
- Follow with fruits and vegetables in pureed form 2
- Progress to other complementary foods as tolerated 2
Introduction Protocol
- Introduce one new food at a time 2
- Wait at least 4 days before introducing another new food to observe for potential reactions 2
- Begin with small amounts (1-2 teaspoons) and gradually increase 2
- Offer foods at normal concentrations, not diluted 2
Common Pitfalls to Avoid
Do not delay allergenic foods beyond 6 months - this strategy does not prevent allergies and may actually increase allergy risk 2, 3
Do not restrict maternal diet during pregnancy or lactation as a preventive strategy for food allergy 1
Do not use hydrolyzed formulas for allergy prevention - these are no longer recommended for this purpose 3
Do not confuse normal responses with allergic reactions:
- Initial food refusal requiring 8-10 exposures is normal 2
- Facial expressions of surprise or disgust are expected 2
- Small gagging episodes while learning oral motor skills are normal 2
- Mild stool changes in consistency and color are expected 2
Warning Signs Requiring Medical Evaluation
Seek immediate medical attention for:
- Persistent or projectile vomiting occurring 1-4 hours after eating 2
- Severe diarrhea with blood or mucus 2
- Skin reactions including hives or facial swelling 2
- Respiratory symptoms such as wheezing or difficulty breathing 2
- Lethargy or significant behavioral changes following food introduction 2
Special Populations
Premature Infants
- Use chronological age (not corrected age) for timing: introduce solids at 4-6 months chronological age 4
- Emphasize iron-rich and zinc-rich foods due to higher deficiency risk 4
- Ensure adequate head control before starting, which may be delayed up to 3 months of corrected age 5