Introduce solid foods at around 6 months old

To satisfy babies' nutritional requirements

• After 6 months old, babies have a higher demand for iron; breastmilk alone cannot satisfy their nutritional needs;
• Apart from breastmilk or infant formula, babies need a variety of foods to provide various nutrients to support their growth and development.

To keep pace with babies' maturation and development

• Eating solid foods helps babies develop chewing;
• Giving babies a wide range of foods, food textures and tastes helps them accept family foods more easily;
• Babies are less likely to become picky eaters if they experience a variety of foods early.

To protect your baby from developing allergy, DO NOT feed him any solid foods before 4 months of age.

What will happen when the introduction of solid food is delayed?

Risk of nutritional problems

Babies may not get adequate nutrients, e.g. iron and zinc, for growth, development and health.

Problems with eating habits

They may not accept a wide range of foods in the future and may thus become picky eaters. Some may refuse food with coarse textures.

Babies develop eating skills

Babies still rely on breastmilk or formula milk as solid foods are first introduced. They gradually drink less milk while adapting to eat various nutritious foods. At around 2 years old, most children dine with the family and eat family meals.

How babies change in the way they eat

1. Sucking breastmilk or formula milk
2. Eating from a spoon and finger feeding themselves
3. Learning to use a cup
4. Feeding themselves with a spoon and eating with the family

How babies accept new food textures

1. Smooth puree
2. Thicker, lumpier food
3. Soft, minced or chopped food
4. Food cut into small pieces

Set a good example for babies

Babies tend to copy parents' eating behaviours and food choices. To help your baby form good eating habits, you should:

• Consume a balanced diet and limit snacks of high sugar, fat and salt. Exercise regularly and maintain a healthy lifestyle;
• Let your baby try foods that you like as well as foods that you dislike;
• Avoid making negative comments about foods.

Develop new skills

Babies are not only taking nutrients from foods but also learning new skills

• Learning to chew
  • Develops babies' abilities of chewing and swallowing.
• Learning to accept different tastes
  • Trying new foods allows babies to learn about the tastes of different foods;
  • Fosters babies' interest in foods
• Developing the skill of feeding themselves
  • Babies learn to eat with spoon and drink from cup;
  • Babies learn to feed themselves.
• Eating as a family
  • Babies learn to eat properly at table;
  • Babies learn to eat socially.
• Developing relationships with family members
  • Good interaction during feeding enhances parent-child relationships;
  • Eating together allows you and your baby to enjoy a happy family time.

How do you know that your baby is ready for eating solid foods?

(Watch related video: http://s.fhs.gov.hk/d1m2u)

Your baby can try solid foods if he has the following signs:

Movements

• Sitting well against the back of the chair;
• Holding his head up;
• Reaching out his hands to grasp objects.

Eating behaviours

• Showing interest in food;
• Opening his mouth for a spoon;
• Closing his lips over the spoon;
• Able to swallow food.

The age when babies first show these signs highly varies, but most babies have these behaviours at about 6 months old.

Premature babies can start eating solid foods when they are 6 months of age counting from the expected date of delivery and have these signs.

Discuss with your doctor or nurse if your baby does not show these signs when he is 7 months of age.

Key points when starting to feed babies solid food

• Babies still rely on milk feeding. Do not replace milk feedings at this stage;
• Offer babies puree food 30 minutes before the usual feeding time;
• To begin, give babies 1 - 2 teaspoonful puree at a time. Gradually increase the amount if babies eat well;
• Choose foods that are iron-rich and can be made into smooth puree；
• After trying smooth and runny food, babies can move on to try thicker food textures.

What are the suitable food choices for babies to start?

(Watch related video: http://s.fhs.gov.hk/5zj3e)

The first foods to start should be rich in iron and the texture should be smooth for babies to swallow. Choose foods that are soft and can be made into smooth puree.

Grains: Infant cereal (rice, wheat, oat etc.), strained congee

Vegetables that can be easily pureed: Pumpkin, Chinese spinach, spinach, sweet potato

Ripe and soft fruit: Banana, pear, peach, apple, papaya

Meat, fish or eggs: Meat, egg yolk, fish, pork or chicken liver

• As long as the foods are iron rich, there is no particular order that foods should be introduced;
• You may offer iron-fortified infant cereal for 3 to 4 days and then add meat, vegetables or fruit puree. You can feed him the puree directly or mix them with infant cereal when serving;
• Give vegetables for babies to try early so that they will accept other vegetables and fruits more easily.

Iron rich first foods

• Offer your baby foods rich in iron, such as egg, dark green leafy vegetables, livers, tofu, lentils, fish and meat. These foods can be pureed easily;
• Take spoonful of these foods, such as egg yolk. Make into a puree or a paste with milk;
• Or mix these foods with congee, infant cereal etc;
• Please refer to the "7-day Healthy Meal Planning Guide for 6 to 24 month old children".

How to prepare baby food

Tools

Use a fine grater, strainer or sieve, or a blender to prepare puree for your baby:

Baby food DIY

How to make infant cereal

(Watch related video: http://s.fhs.gov.hk/z9yiz)

1. Put infant cereal powder into bowl.
2. Mix well with warm water, breastmilk or formula milk, according to instructions on the package, to make a smooth puree.
3. Adjust the amount of water or milk to get a suitable texture.

Useful tips: Adjust the thickness of puree by adding water or milk.

For details, please refer to the " 7-day Healthy Meal Planning Guide for 6 to 24 month old children".

FAQs about first foods

1. How does infant cereal compare to rice congee?
   • Iron-fortified infant cereal contains more iron than rice congee (read the nutrition label on the package to check if iron is added);
   • Infant cereal is a convenient choice for some parents when babies first try solid food;
   • When babies get used to eating puree and demand more, parents can offer them congee with iron rich foods from the family food basket;
   • The iron provided by egg yolk, liver, green leafy vegetables, tofu, fish and meat can be absorbed easily. Changing tastes and textures of congee also help them adapt eating different foods and helps them chew.
2. Are green leafy vegetables suitable for babies?
   • Green leafy vegetables are rich in beta-carotene, iron, calcium and fibre, providing nutrients for babies' growth;
   • Green leafy vegetables are not as sweet as pumpkins or carrots, but most babies accept them well.
3. Should mothers continue breastfeeding when solid food is introduced?
   • Mothers should continue breastfeeding. Breastmilk continues providing babies nutrients and protection against infection. Breastfeeding alongside with introducing solid foods also reduces babies' risk in developing food allergy and autoimmune diseases like type 1 diabetes mellitus.
4. My baby takes "No. 1" formula, does he have to change to "No. 2" formula?
   • He can continue with the "No. 1" infant formula he use to or change to "No. 2" formula after 6 months. Nevertheless, switching to "No. 2" formula is not necessary;
   • Babies can obtain sufficient nutrients from breastmilk or infant formula in addition to a diet including a variety of nutritious foods.

Preparing for mealtime

Mealtime can be more enjoyable for you and your baby if some preparations are made.

Four steps of preparing for mealtime

1. "Warm-up" your baby

   • Before feeding, clean your baby's hands and face and set up a regular activity, say putting on the bib, chatting with him.

   Purpose: To let babies know that “it is time for mealtime”. This helps them to settle on a daily routine.

2. Remove distractions

   • Turn off the TV, electronic devices and put away toys;
   • Keep your baby's attention on you and eating.

   Purpose: To prevent problems resulting from eating while playing with toys or watching TV, such as:

   • Over-eating because of distractions;
   • Older babies may focus on watching TV and eat less;
   • Babies become less interested in feeding themselves.

3. Get yourself prepared

   • Your baby eats according to his needs. Do not worry on how much food he eats;
   • Prepare for the mess when your baby learns to self-feed. For example, cover the floor with newspaper.

4. The sitting position

   • Let your baby sit on a regular chair;
   • Sit with your baby face-to-face at the same level to encourage communication.

   Purpose: Parent can observe babies more easily:

   • how he eats;
   • his intention to self-feed;
   • how he reacts to new foods;
   • whether he is full or hungry.

By getting used to sit on a regular location and seat for feeding, babies associate sitting on that chair and “it's time for food”. It helps babies get prepared and settle themselves during mealtime. The seat should be safe and comfortable. A high chair or a booster chair is ideal.

Avoid restraining your baby in the high chair for more than 1 hour at a time.

With a food tray attaching the chair, babies can reach food and feed themselves easily.

Parents should note the following if babies are fed in the following positions:

Sitting on your lap ➜ It may be hard for you and your baby to see each other face-to-face.

On the flooring mat ➜ Feeding may be difficult once he can crawl or walk. It is difficult for them to form the habit of "sitting down and eating".

On pushchair or baby walker ➜ Babies can climb out of the pushchair, or move around with the baby walker. They will not learn to sit down to eat.

How should parents feed babies with a spoon?

Baby spoon

• Wash baby's feeding utensils with soapy water or detergent. Sterilisation is not necessary.
• Soft tip
• Scoop size holds a mouthful of food
• A long-handled spoon is easy to pick up
• The material is unbreakable and baby-safe

When should you feed your baby solid food?

• Offer solids when your baby is relaxed. When he is too hungry or sleepy, he will be impatient to try solid foods;
• Offer him a small amount of puree foods 30 minutes before the usual feeding time when he feels a bit hungry;
• Let your baby taste the new food in the day time. It will be easier to observe any reactions.

How to feed your baby food puree:

1. Get your baby prepared and bring him to the seat. (Please refer to “ Preparing for mealtime”)
2. Let your baby see the food on the spoon.
3. When he opens his mouth, hold the spoon level on his lower lip.
4. When he closes his mouth, take the spoon out gently. Do not pour the food into his mouth.

Hints:

1. If your baby cannot swallow the puree or he pushes out the spoon with his tongue, he is not ready for solid yet. Try again a week later;
2. Babies may drop some food from the side of their mouths at first. This will improve gradually as they become more skillful in chewing.

How much to give

• Begin with 1 - 2 teaspoons of puree once a day;
• Offer more if your baby enjoys. Increase the amount and frequency gradually;
• Offer your baby milk after feeding the solid foods. Do not cut milk feedings at this stage.

When babies get used to eating the smooth puree

• Increase the amount and the feeding of solid foods to 2 - 3 times a day;
• Gradually adjust the food texture. Change to offer thick puree and soft mashed foods (please refer to the “Moving on” booklet);
• Introduce new foods one at a time so as to build up babies' experience with food tastes. You can add new foods and serve with foods that baby has already tried.

“Rules”for introducing new foods:

• Food must be cooked thoroughly;
• Introduce new foods one at a time;
• Start with 1-2 teaspoons and increase the amount gradually. Try the food for 2 - 4 days before introducing another new food.
• Observe for any allergic reactions (refer to Babies and food allergies). If there is no allergic reaction, then try another new food.

How can we make mealtime enjoyable?

1. Follow your baby's pace
   • Feed as fast or as slow as your baby eats;
   • When he loses interest in the food, call him softly to draw his attention;
   • Stop feeding when he shows signs of fullness.
2. Talk with your baby while feeding
   • Talk to him softly. Smile at him. These help him relax and eat better;
   • When your baby talks to you, respond to him promptly. This makes him happy;
   • Lack of communication makes him feel bored and anxious.
3. Allow babies to take part
   • When your baby shows interest in the spoon or food, let him touch and hold it or feed himself. Offer assistance if required.
4. Give babies encouragement
   • Praise your baby with words and body language when he tries new things;
   • Show him how to do something and he will be happier to try;
   • When he does well, praise him. Then, he knows that he has done the right thing.

Understand babies' signs of hunger and fullness

• Babies know how much they need to eat;
• They show the signs of “I am hungry” or “I am full” through body language;
• Most babies feel full within 15 to 30 minutes;
• Let them lead the pace during feeding.

Signs of hunger

1. Looking at food with interest;
2. Moving the head closer to the food and spoon;
3. Leaning towards the food;
4. Fussing or crying when too hungry.

Signs of fullness

1. Less interested in eating;
2. Eating more and more slowly;
3. Turning her head away;
4. Pursing her mouth;
5. Spitting food out;
6. Pushing away or throwing the spoon and food;
7. Arching her back.

Hints:

If your baby gets full but you keep feeding him, your baby may:

• Feel uncomfortable;
• Link eating and discomfort together;
• Struggle with you during mealtime, and he may end up eating less;
• Over-eat which easily leads to obesity.

Babies' appetite

Babies require adequate nutrients to grow, but babies who eat more may not necessarily grow taller. Growth is also controlled by genes and affected by development during pregnancy. Overfeeding may lead to obesity and related health problems.

• Actually, babies know how much to eat to get the right amount of nutrients for their growth and activities;
• In the first three months of life, babies grow very fast and therefore they eat more;
• When growth slows down, babies need less nutrients. Therefore, they eat less. It is normal that sometimes they do not seem to eat anything, but are still active and lively.

For a baby to grow healthily, the parents' job is to:

• Provide nutritionally appropriate and safe food;
• Feed babies according to their appetite.

Babies' appetite varies from meal to meal:

• Every baby is unique, so do not compare your baby's appetite with others' ;
• Babies eat more after activities but sometimes refuse to eat when they get tired;
• When they grow quickly, they eat more.

The ideal way to feed babies is to go according to their appetite. Do not insist that your baby eats the same amount at each meal.

Common questions from parents

Concern of a father : “My baby is 4 months old. His feeding is not regular, sometimes taking more, sometimes less. He gets distracted easily as well. If I feed him following his reactions, he might not get enough and cannot settle on the feeding schedule.”

It is very common for parents to have these worries. You will be less anxious when you understand why your baby eats and behaves in this way:

1. Parents worry that babies may not get enough because they do not know the right amount to eat
   • Babies are born with a well-built system telling them when and how much to eat. When they are hungry, they will tell parents by body language. If parents feed babies once they show they are hungry, surely they shall get enough.
2. Parents worry babies may not get enough, as they are easily distracted
   • Parents should remove any objects that may distract children before mealtimes;
   • When baby is hungry, he usually eats faster and more attentively;
   • If a baby pauses and looks around, let him take a break. Then, call him to draw his attention to the food;
   • If he is still not interested in the food, that means he is full.
3. Parents worry that the amount of food taken changes from meal to meal
   • Babies' appetite varies from meal to meal. When they ate less in the last meal, they shall eat more in the coming meal or earlier. If parents feed them according to their full and hungry signs, they will be satisfied.
4. Parents worry that babies will not eat at regular times
   • In general, babies at 3 to 4 months have their own sleeping and eating patterns;
   • During daytime, most babies will not be hungry until 3 to 4 hours after feeding;
   • Feeding babies when they are not hungry disturbs their daily routine;
   • Forcing babies to follow your timetable may upset their regular eating patterns.

Foods and drinks that babies should avoid

1. Drinks with added sugar will damage babies' teeth
   • Glucose water:
     • Glucose drink does not help babies form the habit of water drinking.
   • Fruit Juice:
     • Infants do not need any fruit juice;
     • They get more nutrients and dietary fibre from pureed or sliced fresh fruit;
     • Toddlers 1 to 3 years of age should have no more than 120ml fruit juice a day if consumed.
   • Honey:
     • Honey may contain clostridium bacteria;
     • Do not give honey to babies under 1 year old, as their immune systems are immature.
2. Tea, coffee & drinks containing caffeine, such as energy drinks or soft drinks
3. Fish with high levels of methylmercury
   • This includes shark, swordfish, marlin, tuna (includes big eyes, bluefin, albacore, yellowfin species), king mackerel, splendid alfonsino, orange roughy, yellowback seabream and dash-and-dot goatfish.
4. Uncooked foods and unpasteurised milk products
5. Food that leads to choking easily
   • Food with small and hard pieces: e.g. corn, peanuts, nuts, seeds;
   • Food that is crispy or hard: e.g. candies, uncooked vegetables;
   • Fish and meat with bones, and fruit with seeds.
6. Salt, soy sauce, chicken powder
   • Babies may not easily accept bland-tasting food if they get used to salty tastes;
   • Taking too much salt will increase their future risk for high blood pressure.

Babies and food allergies

A food allergy is an immune response against certain food.

Signs and symptoms of food allergies:

Symptoms may occur within several hours or several days after eating the food:

• Symptoms that occurs within several hours:
  • Common symptoms:
    • Urticaria, worsening eczema;
    • Swollen eyes, tongue, face, mouth and lips;
    • Watery stools, vomiting.
  • Relatively rare but serious symptoms include:
    • Difficulty in breathing, fainting.
• Some babies may have an allergic reaction 1 or 2 days later: e.g. eczema, persistent vomiting, wheezing, constipation, stomach pain.

Foods that commonly cause food allergy

Milk products, eggs, peanuts, fish, shellfish, nuts, wheat (e.g. bread, biscuits), soy, bird's nest.

When can babies try these foods?

• Babies should not be given any solid foods before 4 months of age ;
• Parents can introduce these foods when they start eating solid foods at about 6 months;
• Delaying or avoiding these foods cannot prevent babies from developing atopic dermatilitis (eczema) or other allergic diseases;
• For babies with severe eczema or known food allergy, their parents should discuss with their paediatrician or family doctor before introducing these foods.

If you think your baby has a food allergy:

• Consult your family doctor as soon as possible. Stop giving the foods that you suspect is the problem until you have doctor's instruction;
• If the reactions are serious, bring the baby to hospital immediately;
• Babies diagnosed with food allergies must follow doctor's instruction on choosing food.

Reminder to parents

• At around 6 months, introduce solid foods to your baby to meet his nutrient requirement. Continue breastfeeding to allow him to obtain antibodies from the mother. This also benefits his long term health as well as the mother's;
• Do not give your baby any food other than breastmilk or infant formula before 4 months of age. Consuming solid food too early, your baby will take less breastmilk and runs a higher risk of developing allergy;
• When preparing his first foods, choose foods that are iron rich and from the family's food basket to provide variety (grains and cereals, vegetables, fruits, eggs, meat or fish);
• Introduce new food one at a time and start with a small amount;
• Your baby needs time to accept new foods. If he spits the food out or refuses to eat, do not force him, try again several days later.

If you have any queries about feeding your child, please contact your doctor and nurse.

To learn more about healthy eating for 6 to 24 month old children, please refer to the booklets " Moving On", " Ready to go" and " 7-day Healthy Meal Planning Guide"