INTRODUCTION TO SOLIDS

Presented by:
Dominique Schellenberg, RD BASc
Registered Dietitian
 OUTLINE
!  Recommendationsfrom WHO and Health
Canada about breastfeeding and introduction of
complementary foods

!  Learnabout what and how to feed your baby/

introduce solid foods

!  Food Safety

!  Questions/discussion

!  Group survey and wrap-up

 WHO and Health Canada recommendations:
!  Infants start breastfeeding within one hour of life; they should be
placed skin to skin with mom immediately after being born and
stay there for at least one hour or until the first feeding is
complete or as long as mom wishes

!  Infants are exclusively breastfed for 6 months, with timely

initiation of adequate, safe and properly fed complementary
foods

!  Continue to breastfeed for up to two years of age or beyond

SIGNS YOUR BABY MAY BE READY FOR SOLIDS…

Generally babies can do these things by 6 months of age:

!  Hold her/his head up
!  Sit up in high chair and lean forward
!  Let you know when they are full
!  Pick up food and try to put it in their mouth

Babies go through growth spurts around 3 weeks,

6 weeks and 3 months.
This is NOT a sign that infant cereals are needed.
REASONS TO WAIT UNTIL 6 MONTHS

Physiological
!  Infants digestive system and kidneys are immature
!  More likely to develop food sensitivities and allergies
!  Strong extrusion and gag reflexes
!  Not able to sit up or hold up head

Nutrition
!  Reduces intake of breast milk
!  Nutritionally unnecessary before 6 months of age
WHY DOES YOUR BABY NEED SOLID
FOODS AROUND 6 MONTHS?

!  Needs extra iron

!  To introduce new flavours and textures
 INTRODUCING SOLID FOODS
o  Introduce one new food at a time. New vegetables, fruit, meat
and most grains can be introduced daily. Leave more time
between new allergenic foods (will discuss more later.)

o  Work up to offering solids 3-4 times daily before 9mos and 4-5
times daily after that

o  Have baby sit upright (i.e. in highchair). Sit in front of and facing
your baby.

o  Offer when baby is alert. Wait for baby to pay attention & open
mouth. 

o  Look at him/her. Talk to him/her in a kind, encouraging and

quiet manner.
 INTRODUCING SOLID FOODS
o  Offer solids from a spoon about a foot away so it can be seen.
o  Offer small amounts at first. Follow baby's lead.
o  Don't force new foods. Let baby decide how much/what to eat.
Stop when baby loses interest.
o  Feed the way baby wants to eat: a little or a lot, fast or slow.
o  Let baby self-feed from the beginning. A mess is OK! More on
baby-led weaning/feeding soon.
o  Babies need to explore food to get more comfortable with it. This
may mean playing with it, touching it, putting it in their
mouth and spitting it out...it’s all part of developing a normal
and healthy relationship with food!
o  May see a change in bowel movements (colour, odour, consistency
and frequency). This is normal.
 BABY-LED WEANING/FEEDING
!  What is it?
!  Babies learn to eat by feeding themselves

!  When is it not safe?

!  Babies who are at higher risk of having a hard time
swallowing safely – cleft palate, tongue tie,
developmental delay or genetic disorders

!  Babies at risk of anemia should be seen by a health

professional (MD, dietitian) – premature babies,
babies with low birth weight (<3000g), concerns r/t
growth, babies born to an anemic mom, vegan
babies, babies with early intro of cow’s milk
 BABY-LED FEEDING – Cont’d
!  What’s Important?
!  Babies should be sitting upright at 90 degrees

!  Foods should be soft enough to mash against the roof

of the mouth and about the size of an adult pinkie
finger

!  Offer one high-iron food and one high-calorie food at

each “meal” along with one easy to eat food (maybe
to provide Vitamin C.)

!  You need to allow more time for eating and watch

your child closely
 BABY-LED FEEDING – Cont’d
!  Last bit of important info:
!  Know the difference between gagging and choking;
learn what to do in case of choking (baby first aid
highly recommended)

!  Avoid giving foods that babies are more likely to

choke on – hard round foods

!  Iron-fortified baby cereal can be spread thickly on a

soft food like a toast strip or vegetable; it can also be
put onto a spoon and left for the baby to pick up; you
can also add baby cereal with iron to recipes like
home-made muffins
 WHAT TO START WITH?
At 6 months babies need foods that are rich in iron because their
body stores of iron are starting to run out. Offer iron-rich foods
at least twice daily.

Iron-rich foods include:

!  Iron-fortified baby cereals -start with single grain (rice, oat)
!  Meat such as well-cooked chicken, beef, pork and fish
!  Meat alternatives such as beans, lentils, cooked eggs

Good sources of vitamin C are also important because vitamin C

can help with the absorption of iron. Vitamin C rich foods
include:
!  Many types of vegetables and fruits including apples, pears, berries,
kiwi, mango, sweet potato, broccoli, peppers, cabbage, tomato, etc.
!  These can be introduced once your baby is used to having a variety
of iron-rich foods
 ORDER OF INTRODUCTION
6 months- Iron rich foods (i.e. iron fortified infant cereal +
meat & alternatives)
6+ months- Vegetables and fruits, grain products, meat &
alternatives, dairy products & alternatives (yogurt,
cheese)
12 months- fluid milk (whole milk)

!  Avoid added sugar, salt etc. during the first year

!  Choose foods that are part of the food groups

!  Fruits and vegetables, grain products, milk and alternatives,

meat and alternatives
!  Do not give foods like chips, fries, fast food, sweets,
processed meats (hot dogs, bologna, deli meat) and dessert
EXAMPLES OF FINGER FOODS TO GIVE
YOUR BABY

!  Soft, ripe, peeled fruit – i.e. pears, cantaloupe, peaches,

bananas
!  Strawberries, grapes, etc. should be cut into bite sized pieces
!  Cooked vegetable pieces – i.e. cooked carrots, broccoli,
sweet potato
!  Dry toast strips, bread crusts or unsalted crackers
!  Pieces of homemade plain muffins
!  Plain o-shaped cereals (not honey-nut)
!  Small cheese cubes or grated cheese
!  Cooked, tender meat – cut up or ground
!  Cooked pasta
!  Small tender-cooked beans like black beans or navy beans
or larger tender-cooked beans (like kidney beans) cut in
half
 INTRODUCING ALLERGENIC
FOODS
!  There is no evidence that delaying the introduction of allergenic
foods past 6 months, will prevent food allergies in healthy term
infants; you can give allergenic foods after 6 months of age
!  For allergenic foods, allow 2 days between offering additional new
foods until tolerance is assessed; if no reaction on introduction,
offer a few times a week to maintain tolerance
!  Watch for signs and symptoms of an allergic reaction i.e. hives or
rash, vomiting, diarrhea, swelling of mouth or face, blood in stool,
itchy watery eyes (runny nose and sneezing)
!  High risk babies have a history of allergy or a biological sibling or
parent with history of eczema, food allergy, allergic rhinitis or
asthma; these infants should have early introduction of allergenic
foods at 4-6mos. by mixing with breast milk. Do NOT offer before
4mos.
INTRODUCING ALLERGENIC
FOODS
!  Common allergenic foods:
!  Milk - cheese, yogurt
!  Wheat – cereal, bread
!  Tree nuts - almond butter
!  Sesame seeds – tahini (sesame paste)
!  Soy – tofu (bean curd)
!  Seafood – fish, shellfish
!  Mustard - mustard, tomato sauce
!  High risk infants r/t egg and peanut allergy:
infants with severe eczema > pediatrician
/allergist for testing and guidance re: early
introduction (before 6 mos.)
HOW MUCH?
!  Hungry baby:
!  Put hands in their mouths
!  Open their mouth wide for a spoon
!  Reaches for food
!  Paying close attention to the food
!  Upset when food is taken away
!  Full baby:
!  Slow down their eating; losing interest; more playing
than eating
!  Keep mouth shut; lean back from food; turn their
heads when food is near their mouths; spit out food
or get upset
!  Start with 1 tablespoon and work up
 SAMPLE MENU – 6 MONTHS

Early morning -breast milk

Morning -breast milk

(Breakfast) -iron fortified infant cereal mixed with breast milk or
water

Snack -continue to offer breast milk

Noon (Lunch) -breast milk

Snack -continue to offer breast milk

Evening -breast milk

(Supper/Dinner) -plain pureed or finely minced/ground or mashed cooked
meat or meat alternatives or iron-fortified infant cereal
mixed with breast milk or water
Snack -breast milk
 SAMPLE MENU – 11-12 MONTHS*
Early -breast milk
morning
Morning -breast milk
-iron fortified infant cereal mixed with breast milk or water
-chopped strawberries or other fruit
Snack -small pieces of toast, bread, crackers, roti or pita
-applesauce or other fruit
Noon -breast milk
-chopped cooked chicken or other meat alternatives
-cooked brown rice or other cereal grain
-cooked chopped green beans or other veg
-chopped kiwi or other fruit
Snack -cubes of cheese + pieces of a plain homemade muffin
Evening -breast milk
-mashed canned salmon or other meat alternate or meat
-mashed cooked squash or other vegetables
-whole wheat pasta or other grain product
-chopped soft ripe peach or other fruit
Snack -breast milk

*Adapted from “Feeding your Baby Solid Foods, Region of Waterloo Public Health and Emergency Services, 2017
 BEVERAGES
!  Breast milk should be fed exclusively until around 6 months

!  Homogenized milk (3.25%) can be introduced around 12-

months of age

!  Lower-fat milk (skim, 1%, 2%), almond milk and soy milk is not
recommended until at least 2 years of age because of their low
fat content

!  Small sips of water in in an open cup support development of

mature feeding skills!

!  Juice should be limited in the first year. After the first year, only
4 ounces (1/2 cup) per day.
 BREAST MILK STORAGE
!  Store breast milk in containers that have been washed in
hot, soapy water and rinsed

!  Store in small portions to minimize waste

!  Do not fill container – leave room as breast milk expands

as it freezes

!  Indicate the date that the milk was expressed

!  Expect milk to separate during storage – before feeding

swirl the container of milk to mix the cream
 BREAST MILK STORAGE
!  Milk may be stored in insulated cooler with ice packs for up
to 24 hours
!  Milk may be safety refrigerated for up to 5 days (39°F or 4°C),
(store milk in back of fridge where temperature is coolest)
!  Milk may be stored in a freezer compartment located
inside a refrigerator for 2 weeks (5°F or -15°C)
!  Milk may be stored in a refrigerator/freezer with a
separate door for 3-6 months (0°F or -18°C)
!  Milk may be stored in a deep freezer that maintains ideal
temperature for 6-12 months (-4°F or -20°C)

*thaw milk by placing it in a refrigerator over night or in a container

under warm running water or in a bowl of warm water
*milk may be kept in the refrigerator 24 hours after it is thawed
DIVISION OF RESPONSIBILITY

Age 0-6 months

Parent: What
Infant: When, How Much

Age 9-15 months and beyond

Parent: What, When, Where
Child: How Much, Whether
 HOW YOU FEED YOUR CHILDREN IS AS
IMPORTANT AS WHAT YOU FEED THEM

!  Children are very good at regulating their food intake.

Trust them.

!  Parents can either play a positive role or negative role

in their child’s food acceptance and food regulation.

!  Many children react negatively to new foods, but will

usually accept them with time and positive
experiences.
 CHILDREN WILL LEARN TO LIKE A
VARIETY OF FOODS

!  Research tells us that children may taste and remove

new foods from their mouth 10 or 15 times before
they swallow it.

!  Most parents/caregivers give up after the child has

tried a food and refused it 3 times

!  Keep offering a variety of foods from all 4 food groups

 FOOD SAFETY

To prevent food-borne illness:

!  Do not use honey in the first year (risk of botulism)

!  Do not give raw/undercooked eggs
!  Wash hands, utensils, cutting surfaces frequently
!  Follow “best before” dates
!  Wash raw vegetables and fruit well
!  Can freeze baby food for 3-6 months; put dates on the food you
make and freeze

Health Canada, 2004

 FOOD SAFETY

Warming food and liquids:

!  A hot water bath is the safest method.

!  Test the temperature before serving.

!  Be careful if you use the microwave. Microwaves can heat

unevenly and can create hot spots that can burn your baby.
Stir warmed food/shake liquids well.

!  Sterilize water, bottles, nipples and caps until baby is 6 mo.

!  No official safe age to stop sterilizing
!  Throw out leftovers at the end of the feeding
 MEAT OR LEGUME PUREE

Ingredients Method
!  Remove all fat and skin from 1. Place chopped meat or drained
meat before cooking legumes/lentils into a blender.
!  1 cup (250 ml) of cooked and 2. Add 2 tbsp (30 ml) of liquid and
chopped beef, wild game, start to puree. Slowly add
chicken, turkey, fish (no bones), another 1 to 2 tbsp. (15 to 30 ml)
legumes or lentils. liquid until you have a smooth
!  2 to 4 tbsp (30 to 60 ml) liquid. puree.
This can be breast milk, water,
3. Serve baby his/her portion and
or cooking liquid from
freeze the remaining puree. See
vegetables/fruit
Food Safety Tips, Chill.
4. As baby grows older, increase the
texture.

Recipe from: www.healthyalberta.com

VEGETABLE AND FRUIT PUREE
Ingredients
!  Fresh or frozen fruit or vegetables

Method

1. Wash, peel and cut up fresh or frozen vegetables or fruit.

2. Using the stove:
!  Place the vegetable or fruit pieces into a steamer in a small amount of boiling
water and simmer until tender.
Using the microwave:
!  Place vegetable or fruit in a microwave safe bowl with a small amount of tap
water and heat at a high setting until the vegetables are tender, about 3 to 5
minutes.
3. Drain the vegetables or fruit, saving the cooking liquid.
4. Puree the vegetable or fruit with a small amount of the cooking liquid.
5. Serve baby his/her portion and freeze the remaining puree.

Recipe from: www.healthyalberta.com

 FRUIT AND YOGURT SMOOTHIE

Ingredients
!  1/2 cup (125 ml) frozen fruit
!  1/2 cup (125 ml) plain yogurt**
!  1/2 cup (125 ml) whole fat milk (homogenized / 3.25% MF)

Method
1. Place all ingredients in a blender and puree until smooth.
2. Pour 1/4 cup (60 ml) to 1/2 cup (125 ml) into a cup for baby

Alternative suggestion
Frozen Fruit and Yogurt Pops
1. Place 1/4 cup (60 ml) of the fruit and yogurt puree into frozen treat molds
and freeze until firm.
2. Serve as a snack.

Recipe from: www.healthyalberta.com

 OTHER QUESTIONS?
"  Handouts and information
provided
"  regionofwaterloo.ca/ph
“Feeding your baby solid
foods”
"  “Trust me, trust my
tummy” – Toronto Public
Health video on-line
"  Baby-led weaning on-line
info <jessicacoll.com>
"  Book an individual
appointment with your
Registered Dietitian
 THANK YOU!
“Building positive eating attitudes
and behaviours starts at birth …
and lasts for a lifetime.”

Ellyn Satter, 2004