INTRODUCING SOLIDS TO

PREMATURE BABIES

Choosing the right time to introduce solids to premature babies can be confusing. In this fact
sheet we explain what you need to consider when introducing solids to your premature baby.

When to start? How to start?

Premature babies have different nutrition needs to Your baby will enjoy watching others eat. Shared
term babies. The current guidelines suggest starting meals with friends and family will help your baby
solids at around six months in full-term babies. learn about mealtimes.
However, this is not the same for premature babies.
When feeding, place your baby in a secure, upright
Introducing solids before your baby’s digestive position, so they can take food easily. It is okay to
system is ready may increase the risk of allergy. start by feeding baby on your lap; however, using a
If solids are started too late, your baby may be bouncer will allow you to make eye contact with
reluctant to accept new foods. There is also the risk your baby. Later on, place baby in a highchair with a
of anaemia as the baby’s iron stores run low. tray or a seat that attaches to the table so they can
feed themselves with their fingers.
Based on limited available evidence, a corrected
age of three months (the age from the expected due Make meal times pleasant. Choose a time for
date) is the appropriate time to consider the starting solids when you and your baby are happy
introduction of solids for premature babies. The and relaxed, such as mid-morning after a nap. In the
latest time to start is around seven months of actual beginning, offer solids after a breastfeed or formula
age (their age from birth or uncorrected age). so your baby is not too hungry.
As a general rule, most healthy premature babies Use a small plastic teaspoon and put the food in the
will be ready to start solids between five and seven middle of your baby’s tongue. Start with one or two
months (uncorrected age). The exact time within teaspoons and gradually build up the amount.
this two-month time period will depend on your
A lot of babies spit out food when it is offered for the
baby’s gestational age, developmental progress and
first time. If your baby becomes upset or frustrated,
when they show signs of readiness. For example, a
stop and try again in a few days.
baby born at 23 weeks might be ready to start solids
at seven months uncorrected age whereas a baby Playing with food is an important part of learning; so
born at 36 weeks may start at five months. prepare your baby and yourself for a bit of mess.
Using a clean, plastic sheet on the floor can be
Signs of readiness helpful especially when your baby starts finger food.
Before starting solids, your baby should show at
least some of the following signs:
First foods
Foods should be smooth and creamy with no lumps.
• Can sit in a supported position on your lap, Try one new food every two to three days.
bouncer or high chair.
Suggestions for nutritious first foods to offer your
• Can hold his or her head in a stable position.
baby include:
• Often puts hands or toys into their mouth.
• iron-fortified infant cereals
• Leans toward a spoon or food when it is offered
• pureed meat, chicken, fish, egg, beans/lentils or fish
and opens their mouth.
• pureed ripe avocado, apple, banana, potato,
sweet potato (choose one or two at a time).

INTRODUCING SOLIDS TO PREMATURE BABIES – JANUARY 2019 PAGE 1 OF 3

Introducing more foods and textures Home-made vs commercial baby foods
During the first few months of eating solids, breast Use homemade foods as often as possible. Shop-
milk or infant formula will continue to be your baby’s bought jars or pouches of baby foods can be useful
major source of nutrients. when out and about but they do not teach your baby
about the taste of individual foods. They are also
Within one to two weeks or when your baby is
more expensive and can contain less protein than
taking two to three teaspoons at a meal, you can
home cooked meals.
start to offer another meal at a different time of day.
Continue to offer iron-containing foods, more variety
Eating Issues
of fruit and vegetables, plain yoghurt and cow’s milk
on cereal or in cooking. Food refusal
Respond to your baby’s cues and don’t try to force
About one month after starting solids:
them to eat. Babies may refuse food for many
• Offer three solid meals per day reasons, such as if they are unwell, tired or teething.
• Introduce a cup for drinking (cooled, boiled water) Keep meal times to no longer than 30 minutes
• Add in soft finger foods and finely minced foods otherwise your baby may become restless and lose
About two months after starting solids: interest.

• Offer solids before a breast or bottle feed Signs that your baby has had enough include:
• Introduce cut up soft, minced or mashed food with • closing their mouth
small, soft lumps such as minced meat, egg or • pushing the spoon away or spitting food out
cooked lentils • turning their head away
• Offer other foods such as bread, pasta, • getting upset or crying.
dissolvable crackers, fine porridge, quinoa, rice
Between five to eight months old, babies are usually
and cheese
willing to try new flavours but can become more
Your baby will be able to chew soft food even if they reluctant as they get older. Offering new foods twice
do not yet have teeth. They may cough or gag a a week for at least five weeks will often lead to
little when starting lumpy food. This is a normal acceptance.
reaction for many babies trying new textures. Lumpy
Difficulty moving from smooth to lumpy textures
food should be introduced by nine months of age
(from their date of birth) at the latest. Some babies born prematurely have difficulty
accepting lumpy food, particularly if they had a long
As with full-term babies, the later a premature baby period of tube feeding. Try introducing lumpy food
is introduced to new tastes and textures the less gradually by increasing the thickness of purees and
likely they are to accept them. Babies need to slowly introducing soft lumps such as ripe mashed
explore, touch and taste new food at their own pace. banana or avocado.
Offer your baby a spoon at mealtimes even if you
continue to feed them with another spoon. Start Aim to give your baby food that has an even
giving your baby finger food and offer different consistency. For example, avoid smooth purees
flavoured foods separately so they can distinguish with floating lumps (common in commercial
between them. pouches) as the mixed textures may make your
baby gag or choke. Giving your baby home-cooked
Keep offering a variety of food to your baby so that food makes it easy to control the consistency.
by around one year of age they are eating all the
usual family food. Another way to introduce lumps to a reluctant feeder
is by offering finger foods. Babies enjoy finger food
If your baby is formula-fed, full cream cow’s milk can as it gives them more control over what they eat.
be substituted for their main drink after 12 months
corrected age. Limit milk to 500mls in total per day to
ensure your toddler remains willing to eat solid foods.

INTRODUCING SOLIDS TO PREMATURE BABIES – JANUARY 2019 PAGE 2 OF 3

Finger foods to try: The importance of iron for premature
• Ripe, peeled soft fruit such as banana, pear and babies
watermelon Babies born prematurely have lower iron stores than
• Well-cooked, soft vegetables such as carrot, term babies and a higher risk of iron deficiency and
zucchini, pumpkin and broccoli anaemia. Iron is needed to make red blood cells,
• Buttered toast fingers which carry oxygen around the body. It also plays a
• Well cooked pasta shapes role in immunity, brain development and growth.
• Slices of cheese Include iron-rich foods early in the introduction of
solids.
Low food intake
In most cases, healthy premature babies will eat The best sources of iron are:
when they are hungry. It is important to offer a • Red meat (beef, lamb, liver)
range of foods from the different food groups to • Chicken, pork and fish
ensure a balanced diet. Some premature babies
Foods containing moderate amounts of iron include:
can develop feeding problems, particularly those
with long-term health problems. • Iron-fortified breakfast cereals (such as baby
rice/porridge, wheat biscuits)
If you’re concerned about your baby’s growth or
• Lentils or legumes
eating skills, seek the help of a maternal and child
• Eggs
health nurse, paediatric dietitian or speech
• Leafy green vegetables
pathologist.
If your baby is prescribed iron and Vitamin D
Family foods supplements at discharge, continue these until
Your baby will gradually shift from mashed foods to solids are well established or until 12 months of age.
chopped family foods by around 12 to 18 months.
Avoid salty processed foods and adding salt to
cooked foods.
For more information
Maternal & Child Health Line (24 hours)
Offer your baby water at meal times to encourage
T: 13 22 29
them to drink from a cup from about six months
corrected age. References
• British Association of Perinatal Medicine 2011
Allergies Joint Consensus Statement on Weaning Preterm
Babies.
Premature babies have the same risk of developing
• Bliss: for babies born premature or sick 2017
food allergies as babies born at term, so there is no ‘Weaning your premature baby’ (online)
reason to delay introducing solids or particular https://www.bliss.org.uk/parents/about-your-
foods. In fact, introducing new foods to your baby baby/feeding/weaning-your-premature-baby
while breastfeeding may reduce the risk of • Cormack, B, 2013 ‘Section 2: Preterm Baby
Feeding’ in Infant Nutrition Handbook 4th Edition,
developing food allergies. Auckland District Health Board, Auckland
• Palmer, D.J, Makrides, M 2012, ‘Introducing Solid
Foods to Preterm Infants in Developed Countries’
in Annals of Nutrition & Metabolism, No. 60 (Suppl
2), pp. 31–38

DISCLAIMER This factsheet provides general information only. For specific advice about your baby or your healthcare needs, you should seek advice from your health professional. The
Royal Women’s Hospital does not accept any responsibility for loss or damage arising from your reliance on this factsheet instead of seeing a health professional. If you or your baby
require urgent medical attention, please contact your nearest emergency department. © The Royal Women’s Hospital 2015–2019

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