An Integrative Approach to Feeding Your Baby:

Starting Solids and Baby-Led Weaning (Baby-Led Solids)

This handout will give you information about 1) the benefits of breast-feeding and the best time to
introduce solid food and 2) baby-led weaning.

Benefits of Breast-Feeding and the Best Time to Introduce Solid Food

Why should I delay feeding my baby solid food?
Health experts agree that it is best to wait until your baby is around six
months old before offering solid food. The major reason for this
recommendation is that breast milkor formulais the perfect food for
babies. It contains all the nutrients they need. If babies eat other foods
too early, they will miss out on vital nutrients. Most babies will become
ready to eat solids by six to nine months of age. The following
organizations recommend that all babies be breastfed or bottle fed only
(no cereal, juice or any other foods) for the first six months of life (not
the first four to six months):

Courtesy: papaija 2008

FreeDigitalPhotos

American Academy of Family Physicians

http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpolicy.html
American Academy of Pediatrics (section on breastfeeding)
http://pediatrics.aappublications.org/content/100/6/1035.full
Australian National Health and Medical Research Council
http://www.nhmrc.gov.au/guidelines/publications/n29-n30-n31-n32-n33-n34
UNICEF (http://www.unicef.org/nutrition/index_breastfeeding.html)
World Health Organization (http://www.who.int/topics/infant_nutrition/en/)
Some reasons to delay solid foods are listed below. The evidence for some of the
reasons assumes that your baby is breastfed or fed breast milk only. Experts
recommend that solids be delayed for babies that are fed formula also.

Courtesy: David
Castillo Dominici
FreeDigitalPhotos

Delaying solids may give your baby greater protection from illness.
Babies continue to receive many protections from breast milk for as long as they nurse. The
greatest protection occurs while a baby is breastfed only (i.e., eats no solid food). Breast milk
protects babies from disease in over 50 ways. Probably many more ways are still unknown.
One study has shown that babies who were breastfed only for over four months had 40% fewer
ear infections than breastfed babies who also ate other foods.1 Children who receive breast
milk only (no solid food) for at least 15 weeks are less likely to develop an illness in their lungs
at any time during their childhood.1 Many other studies have also linked breastfeeding only to
increased health benefits.
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An Integrative Approach to Feeding Your Baby

Delaying solids will give your baby's digestive system time to mature.
A babys digestive system develops as the baby grows. Babies stomachs and intestines
are not ready to digest food more complicated than breast milk or formula until they are
almost six months old. If solids are started before a baby's system is ready to handle
them, they are poorly digested. This may cause upset stomach, gas, and constipation.
Stomach acid and enzymes needed to digest food do not reach adequate levels until at
least six months of age.
Delaying solids may decrease the risk of food allergies for your baby.
Experts do not agree on this. From birth until somewhere between four and six months of
age, babies have an "open gut." This means that the spaces between the cells of the
small intestines allow proteins, fats and carbohydrates to pass directly into the
bloodstream. This is great for your breastfed baby. It allows helpful antibodies in breast
milk to pass more directly into the baby's bloodstream. Antibodies (sIgA) from breast milk
coat the baby's digestive tract. This can reduce the likelihood of illness and food allergies
before the gut closes. Babies start making these antibodies on their own around six
months of age. By this time, the spaces in the gut will usually close as well.
The open gut also means that large proteins from foods other than breast milk and
formula, as well as organisms that cause diseases, can pass directly into your babys
bloodstream too. In this way your baby could be introduced to allergies and diseases at a
young age. Some studies show that feeding small amounts of food at a very early age
reduces the risk for a child to develop a food allergy.2,3 At this time, we do not have
enough evidence to recommend one approach over the other--i.e., either early or delayed
feeding of solids--to prevent food allergies.
Delaying solids helps to protect babies from iron-deficiency anemia.
Anemia is a condition in which the body has too few red blood cells. (Red blood cells
carry oxygen to all parts of the body.) Giving babies iron supplements or foods fortified
with iron, especially during their first six months, reduces their ability to absorb the iron
they need. Healthy, full-term infants who are breastfed only for six to nine months are
able to maintain normal levels of iron in their blood. In one study, researchers found that
babies who were breastfed only for seven months (and were not give iron supplements or
iron-fortified cereals) had higher iron levels in their blood at one year than breastfed
babies who received solid foods earlier than seven months.4 The researchers found no
cases of anemia within the first year in babies who were breastfed only for seven months.
They concluded that breastfeeding, without adding other foods, for seven months reduces
the risk of anemia.
Delaying solids helps to protect babies from future obesity and diabetes.
Introducing solids early appears to increase body fat and weight in childhood.1,5,6
Increased weight can lead to diabetes.
Delaying solids makes eating easier for your baby.
Babies who start solids later can grab food and get it to their mouths, sit up well, and have
more coordinated tongue movements.
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An Integrative Approach to Feeding Your Baby

When should my baby start eating solid foods?
There comes a time when breast milk and formula no longer supply all your baby's nutritional
needs. A full term baby will start requiring iron from other sources by six to nine months of age.
The calories supplied by breast milk or formula may become inadequate by eight to nine months
of age. A baby may grow well on breastfeeding alone. This is not a reason to delay feeding
solids when the baby is obviously ready for them. Usually your baby will want to eat solids just as
you do. Baby is growing up!
The best time to start solids is when your baby is showing interest in starting. Some babies will
become very interested in the food on their parents' plates as early as four months of age. By
five or six months of age, most babies will be reaching and trying to grab food that parents have
on their plates. A reasonable time to start letting your baby eat is when the baby is starting to
reach for food, grabs it, and tries to put it into her/his mouth. Go by the baby's cues.
A breastfed baby digests solid foods better and earlier than a baby who is fed formula. This is
because breast milk contains enzymes that help digest fats, proteins, and starch. Also, breastfed
babies have already tasted a wide variety of food, since the flavors of many foods the mother
eats passes into her milk. Breastfed babies thus accept solids more readily than babies who
have been on formula. Breastfeeding is amazing!

How should I introduce solids to my baby?

Following are some suggestions for introducing solids to your baby. (Also see page 8 for a
summary that you can post in your kitchen.)
It does not matter what foods you start with or the order you introduce foods. Avoid highly
spiced or high fat foods at first. If your baby reaches for food on your plate, such as a
potato, make sure it is not too hot, and then let your baby have the potato. There is no
need to introduce foods in any specific order. There is also no need for your baby to eat
only one food for a certain period of time.
NOTE: There is nothing magic or necessary about infant cereal. It has little
nutritional value. Your baby is better off eating fruits, vegetables, and meats.
Offer the foods that interest your baby.
Allow your baby to enjoy food. Do not worry exactly how much your baby actually takes
at first. Much of it may end up in babys hair and on the floor anyhow. Why limit the
amount to one teaspoon if your baby wants more?
There is no need to puree foods if your baby is six months of age or older. You also do
not need to waste your money on commercial baby foods. Simple mashing with a fork is
all that is necessary at first Mash the foods the rest of your family will eat prior to
seasoning and offer those to your baby.
Be relaxed. Feed the baby at your mealtimes. As your baby becomes better at eating
solid foods, offer a greater variety of foods at any one time. Do not make mealtimes a
battle. If your baby refuses, or shows signs of disinterest, do not push. Simply offer.
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An Integrative Approach to Feeding Your Baby

The easiest way to get extra iron for your baby five or six months of age is by offering
meat or apricots. You can simmer dried apricots in water and then use a blender to make
them easier to eat. Infant cereal has iron, but it is poorly absorbed and may cause the
baby to be constipated.
If you wish your baby to be vegetarian, the following books offer some good guidelines:
Raising Vegetarian Children: A Guide to Good Health and Family Harmony by
Joanne Stepaniak and Vesanto Melina. Published by McGraw-Hill in 2002.
New Vegetarian Baby by Sharon Yntema and Christine Beard. Published by McBooks
Press in 1999.
There is no need to introduce vegetables before fruit. Breast milk is
far sweeter than fruit, so there is no reason to believe that your baby
will eat vegetables better if you hold off on fruit.
Respect your baby's likes and dislikes. There is no essential food. If
your baby does not like a certain food, do not push it. If you think it is
an important food, wait a few weeks and offer it again.
At about eight months of age, babies start asserting their individuality.
Your baby may not want you to put a spoon into her/his mouth. He/she
may want to take the spoon out of your hand and put it into the mouth
her/himself, often upside down, so that the food
falls on the lap. Respect your baby's attempts at self-sufficiency and
encourage learning.

Baby-Led Weaning
Interest has increased recently in a movement called baby-led weaning. (Weaning, in this
case, does not mean stopping breastfeeding or formula feeding, it means starting solids.) Babyled weaning is a way to introduce solids to your baby while skipping the puree/cereal stage of
foods altogether. This method allows babies to control what they eat by feeding themselves.
There is no spoon-feeding in baby-led weaning! Your baby moves gradually from getting most
nutrition from breast milk or formula to getting most nutrition from solid foods, like older children
and adults do. It is up to the baby to decide how much to eat and what to eat.
At first, your baby may not eat anything at all. He/she may just pick food up. The first foods a
baby eats will add to the nutrients already coming from breast milk or formula. In the beginning,
curiosity motivates babies to try solids, not hunger. Babies do not think to themselves, Boy, I
could use some vegetables, I think I should eat some asparagus. No way. They say, Moms
doing it, my sisters doing it, and I want to be like them! It looks like fun. Eating for a baby is
about a desire to explore the world around her/him and mimic the activities of others.

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An Integrative Approach to Feeding Your Baby

Foods to start with:
Start with whatever you are eating, minus the seasoning. Fruit, vegetables, cheese, meat,
well cooked eggs, bread/toast, rice, pasta are all good options. If vegetables are very
hard, they may need to be lightly cooked so that they are soft enough to chew. Chicken
leg bones can be gnawed on, with a little meat left on. Just be sure to remove any small
bones and gristle before offering it to baby.
To start out, choose foods that are easy to cut into sticks or large strips. At the beginning,
your baby knows how to grasp, but not release, so small finger foods will be too tough to
handle. Babies do best with food that has a built-in handle, like broccoli. The ideal size
will be a piece about the size of her fist.
NEVER leave your baby alone with food.
Foods to avoid:
Nuts
Honey until age one
Foods with added salt and sugar
Fast food
Under-cooked eggs
Foods to modify:
Grapes or small tomatoes should be cut up.
Cherries or olives should be cut up with pits removed.

Common questions people ask:

Wont my baby choke? Lots of parents worry about choking. Doctors do too. There is
good reason to believe that babies are at less risk of choking with baby-led weaning than
with conventional feeding. That is because babies are in control of what goes into their
mouths and at what pace. It is also important to know the difference between gagging
and choking. Gagging occurs when a morsel of food is too large, and your baby pushes it
out of his mouth, away from his airway, with his tongue. Usually with babies, there is a lot
of coughing and spluttering. The baby spits out the food, possibly with some vomit, and
continues as before. It does not bother the baby much. As adults, if we want to gag, we
have to put our finger in the back of our throats. A babys gag reflex is more to the middle
of his tongue, and it moves back as the baby ages. A babys gag reflex is also much
more sensitive than an adults. When this reflex is activated, it occurs when the food is
even farther away from the airway. When a baby has triggered this reflex a few times,
either by putting too much food into the mouth or pushing it too far back, he/she learns not
to do those things. By allowing your baby to put food into her/his own mouth, you are
letting your baby learn how to manage food safely.
Why are there foods marketed as stage 1 foods, age 4-6 months when Im not
supposed to be giving my baby any foods at this age? GREAT question! In some
countries there is a voluntary code of conduct to not promote any food or drink to an infant
younger than six months. Other countries have made this a law. The U.S. has done
neither, so manufacturers can label food as suitable from four months even though the
official view is to wait until six months to start solids.
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An Integrative Approach to Feeding Your Baby

I have a nut allergy. Should I wait until my baby is a year old, or maybe even
longer, before I offer anything with nuts? Thats a complicated question, and one that
interests many researchers. There is a theory called the hygiene hypothesis that may
explain why there has been such a dramatic rise in food allergies in the past 20 years.
Simply put, the hygiene hypothesis says that when an immune system does not have
enough germs (parasites, bacteria or viruses) to fight off from the outside world, it gets
bored. It then turns against itself and causes problems such as allergies and autoimmune
disease. This, some researchers say, is one reason why children raised on farms have
less asthma and food allergies than city kids. Some research suggests that if you
introduce an allergen early (at six to nine months of age), a child may have a decreased
risk of forming an allergy to that food.7 Other studies suggest that it is best to wait until a
child is beyond a year, when the immune system is more mature, to introduce a food that
may cause an allergic reaction.8 As you can see, there is a lot we still do not know about
food allergies and how to prevent them. This is a topic to discuss with your doctor before
making any final decisions.
My baby doesnt have any teeth. Should we wait before introducing
solids? If you have ever been bitten by your toothless baby, you know
that those jaws are pretty powerful, even without teeth! Babies dont
need teeth to bite and chew.
Wont my baby just eat the sweet stuff all the time? Now is the
perfect time to set the stage for good food choices, by offering your baby
a variety of delicious, healthy options. Avoid offering fast foods or foods
with artificial sweeteners or salt. In a study done in the 1930s on orphan
babies who were offered a variety of foods and non-food objects
(including paper!), none of the babies developed any nutritional deficiencies or
inappropriate weight loss.9 Babies give their bodies what they need. As your babys
development continues, you can also offer dips, like yogurt or hummus, so even more
flavors can be tried.

FOR MORE INFORMATION ON BABY-LED WEANING

Book
Website

YouTube

YouTube

Baby-Led Weaning: The Essential Guide to Introducing Solid Foods and Helping
Your Baby to Grow Up a Happy and Confident Eater.
by Gill Rapley & Tracey Murkett, published in 2010 by The Experiment.
Baby-Led Weaning: The fuss-free way to introduce solid foods.
www.rapleyweaning.com/
Baby led weaning feature on BBC London.
http://www.bing.com/videos/search?q=baby+led+weaning+BBC+London&view=de
tail&mid=07121B41ADA7D0F9880307121B41ADA7D0F98803&first=0&FORM=N
VPFVR
Baby knows best! Study shows baby-led weaning promotes healthy food
preferences.
http://www.bing.com/videos/search?q=you+tube+baby+knows+best&mid=375C3E
AD1FD2D734E53E375C3EAD1FD2D734E53E&view=detail&FORM=VIRE8
See page 8 for a summary of successful baby-led weaning.
PATIENT HANDOUT
University of Wisconsin Integrative Medicine
www.fammed.wisc.edu/integrative

An Integrative Approach to Feeding Your Baby

REFERENCES
1. Wilson AC, Forsyth JS, Greene SA et al. Relation of infant diet to childhood health: seven year
follow up of cohort of children in Dundee infant feeding study. BMJ. 1998;316:21-25.
2. Norris JM, Barriga K, Hoffenberg EJ et al. Risk of celiac disease autoimmunity and timing of gluten
introduction in the diet of infants at increased risk of disease. JAMA. 2005;293:2343-2351.
3. Ivarsson A, Myleus A, Norstrom F et al. Prevalence of childhood celiac disease and changes in
infant feeding. Pediatrics. 2013;131(3):e687-e694(doi:10.1542/peds.2012-1015).
4. Pisacane A, De Vizia B, Valiante A et al. Iron status in breast-fed infants. J Pediatr.
1995;127(3):429-431.
5. von Kries R, Koletzko B, Sauerwald T. Breast feeding and obesity: cross sectional study. BMJ.
1999;319 (7203):147-150.
6. Kalies H, Heinrich J., Borte N et al. The effect of breastfeeding on weight gain in infants: results of
a birth cohort study. Eur J Medical Res. 2005;10(1):36-42.
7. Greer F, Sicherer SH, Burks AW. 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):183191.
8. Zeiger RS, Heller S, Mellon MH et al. Effect of combined maternal and infant food-allergen
avoidance on development of atopy in early infancy: a randomized study. J Allergy Clin Immunol.
1989;84(1):72-89.
9. Davis C. Results of the self-selection of diets by young children. Read at the Seventieth Annual
Meeting, Canadian Medical Association, Section of Pdiatrics, Montreal, June 21, 1939.
10. Rapley G, Murkett T. Baby-Led Weaning: The Essential Guide to Introducing Solid Foods and
Helping Your Baby to Grow Up a Happy and Confident Eater. New York: The Experiment, 2010.

The information in this handout is for general education. It is not meant to be used by a
patient alone. Please work with your health care practitioner to use this information in
the best way possible to promote the health and happiness of your baby and yourself.
This handout was created by Samantha Sharp, MD, Fellow, Integrative Medicine Program,
Department of Family Medicine, University of Wisconsin-Madison School of Medicine and Public
Health.
Date Created: April 2013

Notes:

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An Integrative Approach to Feeding Your Baby

Summary

Secrets from Successful Baby-Led Weaning10

(You may want to post this in your kitchen as a reminder.)
Sit your baby upright either in a high chair or on your lap. Make sure your baby is
steady and can use her/his hands and arms freely.
Offer your baby food, rather than feeding. Put it in front of your baby. Let your baby
decide whether or not to try it.
Think of meal times as play times in the beginning. Babies are learning and
experimenting-not necessarily eating. That is okay.
Start with foods that are easy to pick up. Thick sticks or long strips are best at first.
Gradually introduce new shapes and textures, so that your baby can work out how to
handle them.
Do not expect your baby to eat much food at first. Your baby is still getting most
nutrition from the breast or bottle until age one. Many babies eat very little the first few
months.
Expect some mess. Put a plastic sheet under your baby, so that dropped food can be
handed back. Consider a long-sleeve bib or a long-sleeve button down shirt that can be
worn backward to keep your baby clean.
Continue to breastfeed or formula feed as before, so that your babys food adds to the
milk, rather than replaces it. Your baby will reduce feedings gradually when ready.
Offer your baby water to drink with meals.
Try to eat with your baby and include her/him in meal times whenever possible.
Your baby will then have plenty of opportunities to copy you and practice new skills.
Choose times when your baby is not tired or hungry. Your baby can then concentrate
on learning this new skill.
Keep it enjoyable, for everyone! We all know that a relaxed atmosphere is important for
learning. By making sure that mealtimes are relaxed and enjoyable, your baby will be
excited to try new foods and look forward to meal time.
NEVER leave your baby alone with food.

10

From Rapley G, Murkett T. Baby-Led Weaning: The Essential Guide to Introducing Solid Foods and
Helping Your Baby to Grow Up a Happy and Confident Eater. New York: The Experiment, 2010.

PATIENT HANDOUT
University of Wisconsin Integrative Medicine
www.fammed.wisc.edu/integrative