The time when parents would begin to feed their babies solid foods (solids) has had a somewhat wobbly historical trajectory. 

Over the past century, parents have been advised to start their children on solids as early as two weeks old and as late as one year. Since 2002, the World Health Organization (WHO) has recommended that infants be exclusively breast-fed for the first six months of life to optimise their growth, development and health, and the WHO further recommends that breastfeeding continue until at least the age of two. The South African Department of Health’s Infant and Young Child Feeding Policy recommends the same.

Globally, trends on introducing solids early vary. In the US, 40% of mothers introduce solids before four months, in Australia 50% of mothers have fed their babies solids by four months and 90% feed solids before six months, with comparable patterns in the UK and in Italy. South Africa’s last Demographic and Health Survey (DHS) (2016) showed that just 32% of infants under six months of age are exclusively breast-fed and that almost a fifth of infants (18%) have started eating some solid food before six months. 

Research has shown that the early introduction of foods (notably maize porridge and commercial infant cereal) and liquids (water, tea, herbal mixtures) other than breastmilk is common in South Africa.

The weaning window – when to start your baby on solid food

But is this necessarily a bad thing? 

Not necessarily, according to Meg Faure, occupational therapist and co-author of several parenting titles including Weaning Sense. “Every baby is different. Some babies are going to need solids earlier and others will be fine on breastmilk and formula. It’s a window between 17 and 24 weeks where babies can be introduced to solids. The line in the sand is that parents shouldn’t introduce solids before 17 weeks because the gut system isn’t ready.” 

If there is such a window, why does the WHO recommend exclusively breastfeeding until six months? “The reason is that the WHO is informing populations that don’t have access to hygienic water, adequate formula milk, and who don’t have access to good, solid nutrition. So, the very best thing for those populations is to exclusively breastfeed, because the most common killer for infants is diarrhoeal disease. So, the WHO is putting a helpful line in the sand for developing populations. The challenge is the perception that if exclusively breastfeeding is best until six months, then it must be best for as long as possible, and this just isn’t true.”

An important reason to start solids by six months at the latest has to do with iron. 

Lyndall Metherell, private dietician with a special interest in paediatrics, explains that “iron is particularly important when your baby is four to six months old. This is because during the last few months of pregnancy, newborns build up a store of iron from the nutrients they get in utero. This store of iron lasts for the first four to six months of life. Thereafter babies need to get iron from food sources.”

Infant readiness in starting solids is important since trying to feed a baby who isn’t ready is likely to fail. According to Faure, babies show signs of readiness that parents can look out for. 

“There are physical and social signs of readiness. Physical signs include that the baby can hold their head up off their chest – because they must have head control in order to have mouth and swallowing control. Another is if they are sitting in your lap, and you have your hands on their hips they should be able to sit upright, supported. They need gross motor stability. 

“When they’re not making it from one feed to the next and they’re waking up more often, these can be physical signs that they need more nutrition. Social signs include interest in food and fascination with it. They want to reach for your food and put it into their mouth.” Another sign is that the baby has lost the extrusion (tongue thrust) reflex, which means that they aren’t immediately pushing food back out of their mouth with their tongue. If your baby does this they might not yet be ready.

Puréed foods remain a common starting place for parents, but some sources, such as the useful weaning website Solid Starts, encourage “Baby Led Weaning” where infants are encouraged to self-feed from very early on. Thus, they include a further sign of readiness as the ability to reach and grab for objects and bring them to the mouth. “Often a combination of the two methods (purées and baby-led weaning) works the best – have a bowl of puréed food that you spoon-feed as well as some soft finger foods that your baby can feed themselves. Expect a mess, follow your baby’s hunger and fullness cues (never force them to finish the whole bowl), and remember to do what works best for your family” says Metherell.

Tiny mouths to feed – how much food do babies need?

Even if you and your baby are both keen and ready to start, you still need to work out how much to offer.

“Babies don’t follow guidelines. On some days they may eat more than others” explains Metherell. “As a caregiver your job is to decide when and what your baby eats and it’s up to your baby to decide how much they would like to eat. This teaches your baby to trust its own satiety and hunger cues and sets them up to have an intuitive relationship with food and their bodies. The best way to know if your baby is eating enough is to take him or her for regular growth monitoring at your local baby clinic. If your baby is following their growth curve, then you have nothing to worry about.” 

The most important thing for parents to keep in mind, according to Anna Olivier, Umatie co-founder, is that “this is their baby’s exciting food journey. Their important job is to introduce as many new flavours and tastes as possible to their little one’s diet to develop their flavour palate so they can grow to love good food from the very start.” 

Metherell agrees, “some babies will really enjoy this experience, and some won’t, so don’t give up and follow your baby’s cues. Milk still makes up most of their energy needs between starting solids and 12 months, and as your baby’s food intake increases their milk intake will naturally decrease. There are three golden rules: Offer simple and unprocessed foods, let your baby get involved in the eating experience (embrace the mess) and avoid ultra-processed foods.”

The advice around trying new flavours and tastes is supported by evidence that shows that early exposure to a wide range of flavours can result in children showing more interest in variety at later ages. Repetition matters too. “If your baby spits out the food or pulls a face, try again. It can take 15 to 20 tries for a baby to accept a new food. The key is exposure, exposure, exposure” says Metherell.

Kath Megaw, paediatric dietitian, co-author of Weaning Sense and founder of Nutripaeds, reminds parents that “solid introduction is a journey and not a destination”. 

At the start, says Megaw, there is no need to worry too much about specific nutrient distribution since the point is just exposing your baby to flavours. But “once feeding is established, in other words your baby is eating two to three regular little meals a day of around 30-45 millilitres per meal, then it’s a good idea to use the following nutrient distribution – a third grains, a third protein and a third veggies or fruit and one to two teaspoons of healthy fats.”

Making food at home in bulk and freezing it in containers or ice-cube trays can help parents who don’t have time to make a separate meal for their baby each and every day. 

Homemade food also gives parents control over the ingredients (including the salt and sugar content of their meals), and is a sure-fire way to avoid allergens and ingredients that aren’t recommended for babies, such as honey. “When making homemade foods you have control over the ingredients used, the texture your baby prefers, and often there is less wastage as you can freeze leftovers. This often leads to saving money,” says Metherell.

Addressing allergies – what parents should know

Whether a parent decides to start at six months or earlier, or wait for the signs of readiness, there is evidence that introducing solids to an infant by four months might have benefits such as increasing their willingness to eat a variety of fruits and vegetables later in life, decreasing their risks of having feeding problems later in life, and decreasing their risk of developing food allergies.

Dr Candice Royal, paediatrician and allergologist at the Kidsallergy Paediatric and Allergy Centre in Cape Town, explains that “in the past parents were advised to delay introduction of the common food allergens to prevent the development of food allergies. 

“We now have good evidence that the contrary is actually true – early introduction, especially in infants considered high risk (those with a family history of food allergy or early-onset eczema), should be introduced to common food allergens within the first year of life. Early introduction is protective! Allergens should thus be introduced when complementary foods are started at four to six months.

“The six big allergens that parents should be aware of are cow’s milk, egg white, soy, wheat, fish and peanuts. I would also add tree nuts, legumes and shellfish. However, parents do need to be aware that one can be allergic to proteins in almost any foods, hence the advice to always introduce one food at a time to allow recognition of an allergic reaction.” If an allergy is suspected parents should seek help from a healthcare practitioner who is experienced in the diagnosis and management of food allergy. “The food in question should not be offered until this assessment. The goal is to ensure a child’s diet is as full and varied as possible but also safe, as allergic reactions can be very severe and even life-threatening,” says Royal.

For the non-chefs, store-bought items provide another option

Parents without a culinary bone in their body, or without the time to prepare baby food, needn’t fear. Shopping in-store or online for pre-made foods has never been easier and there are a huge range of local options including Woolies Babes, Umatie, Ucook (with Weaning Sense), Purity, Squish, Rooted Natural and Nutri-Kids.

But taking the easier route to getting the food doesn’t mean you can stop paying attention to what your baby eats, explains Metherell. “Ingredients are always listed in descending order according to the amount of the ingredient that is in the product. 

“You want to choose a product with a short list of ingredients and avoid ones that have preservatives and flavourants added (the ‘E’ numbers.) Some brands will claim to have no ‘added sugar’ but fruit is added to increase sweetness – again check the ingredient list. The recommendation for children under two years old is to exclude all added sugars – rather choose the natural forms, such as fruit and dairy, etc.”

If parents are worried about allergens in pre-made foods, the good thing to know is that “in South Africa the common food allergens have to be listed on every food label. If your child has a food allergy it is very important that the label of pre-prepared food is checked three times: at the time of purchase, at the time of packing away at home, and at the time of preparing to serve to your child,” says Royal.

Whether pre-made or homemade, the journey to introducing solids to a baby will have its ups and downs that require parents to be patient and to measure their successes in weeks, not in meals, says Metherell. 

“There are so many factors that influence how much a baby will eat at a meal as well as on a certain day. These could include the timing of the meal and milk intake, how tired they are, whether they are going through a growth spurt, or how active they’ve been during the day. Due to this, try not to become despondent if your baby doesn’t finish his or her food at each meal. If you are concerned, look at what your baby has eaten over the week. Monitoring your baby’s growth regularly at your local baby clinic is the best way to check if your baby is meeting all his or her nutritional requirements.” DM/ML/MC

In case you missed it, also read How to train your baby (to sleep)

How to train your baby (to sleep)