At what age should solids be introduced to an infant?

Recommended Age to Start Solids

Introduce solid foods between 4-6 months of age, with 6 months being the preferred target age, ensuring the infant demonstrates developmental readiness including good head control and ability to sit with support. 1, 2

Timing Framework

The introduction window is clearly defined:

• Not before 4 months: The infant's gastrointestinal and renal systems are not sufficiently mature before this age 2, 3
• Around 6 months (preferred): This is the optimal target age recommended by the American Academy of Pediatrics 1, 2
• Not beyond 6 months: Delaying past this point increases risk of iron deficiency anemia, inadequate nutrient intake, growth deficits, and feeding problems 4, 1

Developmental Readiness Markers

Before introducing solids, confirm the infant demonstrates:

• Good head control - essential for safe eating 1, 2
• Ability to sit with support 1, 2
• Disappearance of the extrusion reflex 2

Introduction of Allergenic Foods

Potentially allergenic foods (peanut, egg, dairy, wheat) should be introduced at the same time as other complementary foods around 6 months, without delay. 4, 1

This represents a significant shift from older recommendations:

• Delaying allergenic foods beyond 6 months does not prevent food allergies and may actually increase risk 4, 1
• For standard-risk infants, introduce allergenic foods at home without specialist evaluation 1
• For infants with severe eczema or egg allergy, evaluation by an allergist may be warranted before introducing peanut 1

Practical Implementation Strategy

Start with iron-rich foods as first foods:

• Iron-fortified cereals or pureed meats provide approximately 1 mg/kg per day of iron needed at this age 2
• Begin with smooth, thin purees mixed with breast milk or formula 2
• Progress to thicker consistency as the infant adapts 2
• Introduce one new food at a time and wait at least 4 days before introducing another to observe for reactions 1

A practical ordering could be:

1. Iron-rich foods (fortified cereals, pureed meats) 1, 2
2. Vegetables high in iron (broccoli, cauliflower, squash, carrot) 1
3. Fruits 1
4. Allergenic foods introduced alongside other complementary foods 1

Special Populations

Premature infants: Use chronological age (not corrected age) for the 4-6 month window, though ensure developmental readiness is achieved 5

Infants with severe eczema or known FPIES: Consider starting with lower-risk vegetables before rice cereal 2

Common Pitfalls to Avoid

The evidence reveals high rates of non-compliance, with approximately 40-44% of infants receiving solids before 4 months 3, 6:

• Do not introduce before 4 months even if the infant "seems hungry" or "seems ready" - gastrointestinal immaturity is the issue, not hunger 2, 3
• Do not delay beyond 6 months waiting for "perfect readiness" - nutritional deficiencies become a real risk 1, 2
• Do not avoid allergenic foods - early introduction (4-6 months) may actually help prevent food allergies 4, 7

Normal vs. Concerning Responses

Normal responses that should not delay continued introduction:

• Initial hesitation or refusal (may need 8-10 exposures to accept new foods) 1
• Facial expressions of surprise or disgust 1
• Small gagging episodes as oral motor skills develop 1
• Mild changes in stool consistency, color, and frequency 1

Warning signs requiring medical attention:

• Persistent vomiting, especially projectile vomiting 1-4 hours after eating 1
• Severe diarrhea with blood or mucus 1
• Skin rashes, hives, or facial swelling 1
• Respiratory symptoms (wheezing, persistent coughing, difficulty breathing) 1
• Lethargy or significant behavioral changes 1