Breast milk is all your baby needs for many months. It is a complete food, it’s full of health benefits and it protects against illness. Although exciting to move your baby to the next stage, waiting until your baby’s digestive system is ready for solids can help reduce obesity, give greater immunity against infections and may help protect against allergies. Put another way, hurrying them to the next stage is linked with increasing obesity, lower immunity against infection and may put them at a higher risk of developing allergies. This article answers many frequently asked questions about starting solid foods with a breastfed baby.
When will my baby be ready for starting solid foods?
Most authorities around the world recommend that breastfed babies only have breast milk until around six months of age—e.g. UNICEF, World Health Organisation (WHO), National Health Service UK (NHS) , American Academy of Paediatrics (AAP). By this age your baby’s gut, kidneys and immune system are better developed to cope with digestion.
Signs of being ready for solids
Between five and seven months of age your baby will begin to show behavioural and developmental signs that he is ready to start solid food. These include your baby being able to sit up on his own, being able to pick up food between his thumb and forefinger and losing the tongue thrust reflex—a protective tongue reflex that pushes food back out of the mouth in young babies. However the Womanly Art of Breastfeeding explains it simply—your baby is ready once he can reach for food himself and put it in his own mouth.
His insides are designed to be ready for solid food once his outside has developed enough for him to eat it on his own. If he can’t pick up food, get it in his mouth, and chew it without choking, then he’s just not ready for solids, and his tummy probably isn’t ready.
Baby led weaning
The authors of The Womanly Art of Breastfeeding also describe a simple way to go about starting solids by letting your baby decide when they are ready (p179) this is sometimes known as baby led weaning;
As your baby learns to sit (around the middle of the first year), give him a place at the family table or some other regular access to solid food. At the right moment, he’ll reach for food (probably off your own plate), chew it, swallow it, and reach for more. That’s when solids start. (The World Health Organization and many other big organisations having studied the research, agree. They could just have asked the babies!). This is not something you have to do for him, it doesn’t require any special baby foods at all, and starting before six months (unless your baby does it herself) has minuses without pluses. It’s also fine if your baby doesn’t want solids for a good while yet.
Mostly breast milk with solids as an extra
Most babies will not swallow very much food at first, so breast milk still remains the main diet through most of the first year of life, with solids gradually adding to the total calorie intake. As long as breastfeeding is not restricted and you are offering nutrient rich food, you can let your baby decide how much he likes to eat and how often.
Nutrient rich food?
Letting your baby fill up on too many low calorie foods in place of breast milk could result in your baby getting less total nutrition than before solids were introduced. Carlos Gonzalez, a Spanish paediatrician explains more about calorific values of a range of food (plus much more on starting solids and picky eaters) in My Child Won’t Eat!: How to enjoy mealtimes without worry.
Mothers’ milk has 70kcal (kilocalories, commonly known as calories) per 100g (3.5oz). By contrast boiled rice has 126kcal, cooked chickpeas (garbanzos) 150kcal, chicken 186kcal, bananas 91kcal per 100g (3.5oz)—but apples have only 52kcal, oranges 45kcal, cooked carrots 27kcal, cooked cabbage 15kcal, cooked spinach 20kcal, green beans 15kcal and lettuce 17kcal per 100g (3.5oz). And this is providing that these foods have been drained well; if the water they have been cooked in is included, they are even less substantial.
What food and drinks shall I offer?
With a few exceptions, by the time he can reach out for them at around six months, your baby can eat the same healthy table foods as the family. And a breastfed baby may not need anything other than breast milk to drink during the first year. But if he shows an interest, he can practice drinking a little tap water from an unbreakable cup with his meals1. The following resources discuss nutritious first foods, what to avoid and many other tips for introducing solid food.
Starting solid foods when baby has allergies
Robyn Noble, lactation consultant and author of Breastfeeding Works! Even With Allergies explains that not all babies are ready for solids at six months especially babies who have already had a negative reaction to their mother’s diet via breast milk. These babies often can’t handle solids well until around nine to twelve months old. Some babies cope with solids even later than this and they will need to be closely monitored to ensure they are still getting all the nutrients they need from breast milk. Noble suggests stewed pear, sweet potato, stewed apple, pumpkin, avocado and courgette (zucchini) as suitable first foods for an allergic baby. 2
Introducing potentially allergenic foods
Introducing solid foods while continuing to breastfeed is thought to help protect a baby against developing food allergies and coeliac disease.3 The exact timing for introducing potentially allergenic foods to a baby’s diet has been a subject of discussion in recent years. UK’s National Health Service (NHS) recommends:
When you start introducing solid foods to your baby from around 6 months old, introduce the foods that can trigger allergic reactions one at a time and in very small amounts so that you can spot any reaction. These foods are:
- cows’ milk
- eggs (eggs without a red lion stamp should not be eaten raw or lightly cooked)
- foods that contain gluten, including wheat, barley and rye
- nuts and peanuts (serve them crushed or ground)
- seeds (serve them crushed or ground)
- shellfish (don’t serve raw or lightly cooked)
Current advice for peanut and egg (UK)
A 2018 document from the Scientific Advisory Committee on Nutrition (SACN) and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT)4 considered all the available research regarding the best time to introduce peanut and hen’s egg into a baby’s diet. This included two studies56 that looked at introducing potential allergens in a baby’s diet before six months of age. SACN-COT concluded there was not enough evidence to recommend introducing peanut or hen’s egg to an infant’s diet before six months of age. The joint SACN-COT statement recommends:
- Breastfeed exclusively for six months
- Continue breastfeeding while complementary foods are added in an age appropriate form**
- Introduce peanut and hen’s egg alongside breastfeeding between 6-12 months of age
- Once introduced and tolerated, continue to include peanut and egg in the diet on a regular basis
- If a baby is at high risk of allergy, parents can seek medical advice before introducing allergenic food.
- Deliberately excluding peanut or hen’s egg beyond six to twelve months of age may increase the risk of allergy to these foods.
**Refer to the full document warning against giving infants whole nuts (a choking hazard) and raw egg (associated with food poisoning).
Current advice (USA)
In the United States, information from the American Academy of Pediatrics (AAP) differs from UK advice. The AAP state that babies who are at high risk of allergy to peanut can be introduced to suitable baby friendly peanut products from four to six months of age—after allergy testing and under medical supervision 7. Peanut Allergy, an article from La Leche League International’s Leader Today provides a discussion of the research and recommendations for reducing peanut allergy.
What are the symptoms of allergy?
General symptoms of allergy are discussed in more detail in Milk Allergy in Babies. Author Robyn Noble explains that if a baby is intolerant to something when starting solids, parents may notice eczema appearing or worsening, baby may start getting colds and other infections, baby may start fussing or crying more, become more unsettled at night and there may be new breastfeeding behaviour such as wriggling, fussing or biting. Noble explains that allergenic proteins in weaning diets can cause stronger reactions than when encountered via breast milk because the mother’s body will have broken them down into smaller molecules before passing into the milk. Likely problem weaning foods include cows’ milk products such as milk, infant formula, custard and yoghurt (Noble, 2015).
Biting behaviour and allergy?
If breastfeeding problems such as wriggling, fussing and biting at the breast begin soon after starting solids, they may be associated with food allergy and corresponding discomfort. Robyn Noble describes a phenomenon she calls Hypertonic Bite Response to describe how a baby may breastfeed abnormally when they are in pain and very tense. See Baby Biting While Breastfeeding for a summary of ideas to help with this specific cause of biting.
When can my baby have whole cows’ milk?
The NHS and First Steps Nutrition Trust advise waiting until twelve months of age before giving whole cows’ milk as a drink. For much more information about cows’ milk and other alternative milks see:
- Infant Milks: A Simple Guide to Infant Formula, Follow-On Formula and Other Infant Milks (2019) by First Steps Nutrition Trust
- Is it Safe to Use Cow’s Milk or Other Milks as a Supplement to Breastfeeding? by Kelly Bonyata.
How much milk will my baby need during weaning?
Breast milk continues to be the main source of nutrition during the first year of life. A general guide to the volume of breast milk needed per day while babies are exclusively breastfeeding in the first six months is often cited as 750-1035ml per day (25-35oz).8 As baby takes more solid food in the second half of the first year, this volume will gradually decrease but breastfed babies can continue to breastfeed on demand. For an idea of daily volumes of alternative milks needed during weaning see Infant Milks: A Simple Guide to Infant Formula, Follow-On Formula and Other Infant Milks p16.
Will starting solid foods help my baby sleep through the night?
There doesn’t appear to be a link between starting solids and sleeping longer at night. It’s quite developmentally normal to wake at night. If allergenic proteins in a weaning diet affects a baby negatively, infant sleep may be disrupted (Noble, 2015).
My baby’s only four months but he seems hungry
If your baby is going through the four-month-fussies (an age when babies are very distractible), or waking more often at night, you may wonder if he is hungry. You may be right! But there can be lots of reasons for a baby to wake more at night. Try checking out reasons for your baby’s fussiness or you could try these tips to increase your breast milk supply before considering solid food.
Solids before six months?
If you still feel your baby is hungry, and you are struggling to increase your breast milk supply, even after getting good help, you may be confused whether to start supplementing with formula or whether to start solids to fill the gap. Canadian paediatrician Jack Newman has this to say;
most pediatric societies around the world recommend exclusive breastfeeding to six months (but that does not mean exactly 182½ days). Mothers with late-onset decreased milk supply are often told they cannot give solids at five months but must give formula instead if the baby is not gaining well. But in these cases, the baby needs extra calories. If he gets formula, he won’t be exclusively breastfeeding anyway. And giving a bottle will often be the final blow to breastfeeding. If we let the baby eat as much high quality food as he wants, he will get the nutrients and calories he needs to gain more weight, and will still get the nutrients, calories and protection from illness from his mother’s milk.
And Dr Newman goes on to give some guidance on types of suitable high calorie foods (p.113):
babies at this age can eat banana, avocado, mashed potato, ground beef and chicken, the latter two being much better sources of iron than commercial cereals or formula for that matter.
What if there is undigested food in my baby’s nappy?
Opinions seem to vary whether undigested food in the nappy is quite normal even into the second year of life (Dr Jack Newman’s Guide to Breastfeeding p. 286) or whether it is a sign that your baby isn’t ready for solids because adult enzymes needed for digestion aren’t being produced yet (Womanly Art of Breastfeeding, p.249). In Baby Poop the author describes it as follows:
For babies in the first days of starting solid foods, however, if food comes out looking the way it went in, it’s a good sign that baby’s digestive system is just not ready. Although it’s likely not particularly harmful, it seems more appropriate to just wait some weeks before trying again. Food that doesn’t digest can cause some tissue irritation and floral disturbance, and it’s clearly not providing any nutrition.
What if my baby doesn’t seem interested in other foods?
The Womanly Art of Breastfeeding explains that it is not a big deal if your baby isn’t fussed about eating “real food”;
Your milk is all he needs for many months to come, providing a nice wide comfort zone. It’s a complete blend of protein, fat, carbohydrates, vitamins, minerals, electrolytes and fluids, not to mention anti-infective, anti-inflammatory, and immune-system-boosting factors. Your “late-starter” or “long-term dabbler” isn’t missing any developments or milestones. In fact she may sense that her body is more sensitive, and the lack of interest may protect her from foods that could create sensitivities. or she may still need to develop her chew-and-swallow skills. She just needs a few more weeks or months.
Does breast milk have enough iron?
For a full discussion on this topic see Iron in Breast Milk.
When does breast milk stop being beneficial?
Breast milk continues to be beneficial and nutritious from the first drop to the last. Some people are under the impression that breast milk somehow becomes like water after a fixed length of time e.g. six months or 12 months. This is like saying your blood stops being useful after a set time.
let us not be misled, the main reason we do not drink human milk our entire life is that no one would give it to us. Although perhaps not perfect, mother’s milk is the closest thing to the perfect food, at any age, more than any other known food. A castaway on a deserted island could survive longer if he only had human milk than if he only had bread, or only apples, or only chickpeas, or only meat.
What about formula fed babies?
The recommendations for starting solid food at around six months apply to breastfed babies. In her book Milk Matters, author Maureen Minchin discusses that there aren’t any official recommendations for when a formula fed baby should start solid food and she isn’t aware of any research. She concludes:
formula fed infants probably should be offered a wide variety of quality fresh and freshly-cooked foods from about sixteen to twenty weeks onwards, as their in utero body stores of nutrients may be depleted in some way by then.
all infant formula is made up of many different food sources: milk, wheat, soy, corn. In this sense artificially fed infants have already been exposed to a variety of foods via infant formula.
Minchin urges parents to ‘forget about’ toddler milks stressing that they shouldn’t be considered as ‘nutritional insurance’ but rather they cause toddlers to fill up on a processed food instead of eating a nutritious, fresh diet.
Breast milk is a complete food for around the first six months. At about this age babies will start to reach for food off your plate, signalling they are ready to begin solids. Breast milk will continue to be their main source of nourishment during most of the first year.
*Book extracts reproduced by permission from Pinter & Martin.