When to Introduce Solids

While still in the womb, infants receive nutrition via the umbilical cord and placenta. The air and oxygen they need are received in this way as well. As soon as they are born, infants’ digestive and respiratory systems begin to work in a new way, different from the way they worked in utero.

And yet, this transition does not signify that these bodily systems have matured and synchronized with one another: that’s a long process that can take several months and span over multiple stages. In essence, the first stage, coined by many as “gas,” is a significant stage in these systems’ maturation and synchronization. This stage, which normally takes place during the first 3-4 months of life, is exemplified by many phenomena, including spitting up, gas pain, belching and stuck belches, constipation, reflux, hiccups and even spitting up from the nose. All of these phenomena are evidence of a lack of system maturity and synchronization.

Digestive system maturation and food allergies

In the first stages of life, the trachea and the esophagus are not nearly mature enough to separate air and food as they enter the digestive tract and you can see situations where infants burp as air enters their bodies, even in the absence of food. To ensure your infants safely make their way through this initial stage, it’s a good idea to adhere to the advice of most nutritionists: many small meals throughout the day so as not to overload the immature system. In addition, feeds should be slow, to enable the activation of their sense of fullness and avoid overeating.

Once we have successfully made it through the initial stage and maturation has been reached, it will be time to for nutritional replacements. Studies dealing with the introduction of solids tend to discuss allergenic foods and how they are digested by the infant’s digestive system. These studies can be divided into two main camps. The first discusses early exposure of the digestive system to allergenic foods, in conjunction with nursing, to reduce the likelihood of your infant developing food allergies. They believe that from the age of four months, you can feed your infant tastings to expose their digestive system to various allergens. And by tastings, we mean a small amount (teaspoon), not a whole meal, and placed directly into the infant’s mouth, using your own finger. From six months, you can expose your infants to greater quantities of solids, building up to an entire meal that would replace a nursing/bottle feed.

The second group of studies discuss the maturation of the digestive system as critical, so that when the allergenic foods are presented, they will be strong enough to respond to them, cope with them and will not necessarily develop food allergies.

In western countries, it is common practice to go according to the first group of studies, those that stipulate that early expose can reduce the development of food allergies. As such, Israel’s Health Ministry currently and other like bodies around the western world recommend to introduce tastings of solids from the age of four months.

Both of these approaches discuss the risk of infants developing food allergies, but do not cover other topics related to teaching our children proper eating habits. And in a world where obesity is vastly spreading, I believe that it is important that we discuss the other elements that pertain to digestive system maturity, so that we can provide our children with the best possible tools for optimal eating habits.

Motor readiness

The first concept I want to touch upon is your infant’s motor readiness to eat solids. Anyone who has ever tried to feed a four-month-old has surely been exposed to the fact that these tiny human beings do not yet sit, do not know how to chew and are certainly not ready to handle foods that are not in liquid (or pureed) form. Let’s examine this concept in greater detail.

When an infant is born, they do not know their bodies, nor their ability to move about, and they cannot support their own body. As I have already mentioned, the infant’s digestive and respiratory systems are not synchronized with one another - this process takes time and only culminates once the infant is able to hold their body upright independently. Human infant’s aren’t like the offspring of other animals. When they’re born, they don’t immediately start walking; their development is more gradual and they only achieve a total upright position between the ages of 12-18 months, when they start walking independently. And even then, there are several stages along the way. Generally speaking, when an infant learns to sit upright on their own (usually between 8-10 months), their digestive and respiratory systems reach a certain degree of maturation. At this stage you can see how infants who once spat up a lot stop doing so, infants used to nursing or sucking learn to chew, etc. This stage is also ideal for the introduction of solids, from motor and physiological perspectives.

Cognitive readiness

Another aspect - one no less important, is cognitive perspective. Infants who have just been born are highly sensory beings. Their cognition continues to develop throughout their first years of life. At first, they cannot understand that they are separate and independent of their mothers - they gradually acquire this understanding and learn that they have abilities independent of the person they call “mom.” When I, as a mother, try and feed an infant who is not ready to be fed, they won’t always welcome the change. In essence, I would be creating a “worsening of conditions,” as they are used to eating a certain way and I am attempting to change it. As such, feeding infants is not always smooth sailing. I hear from many parents about the need to distract infants so that they’ll eat. Since at this stage, infants cannot tell us if they are hungry or full, I tend to act on my own assumptions. The way I see it, food is supposed to replace the milk meal at some point, while the infant may see it as yet another life experience. The food reaches the infant, only in a different way. I can try and distract the infant in many ways (seating them for mealtime in front of the television, playing “airplane,” telling a story and sneaking a spoon in, presenting solids in a bottle with a wider nipple and more. Yet, in this way, I would be creating a conflict of interests experienced in conjunction with the infant’s hunger/satiation mechanism.

During the initial solids introduction stage, parents tend to feed on an incline (like in a bouncer seat), which increases the infant’s resistance to food, as it places a lot of weight on the neck and makes it unpleasant to swallow. Yet, as the systems are not yet synchronized, food can inadvertently enter the respiratory system, resulting in gagging and even vomiting. I recommend that parents who opt to feed according to the early exposure method hold their infants at a 90 degree angle while providing support to their upper bodies (seated on you as you support them from beneath their underarms) and then feed them. The more upright they are, the easier it will be for them to swallow, and the more pleasant their feeding experience will be.

During the second stage, when the infant can already sit independently - know that feeding them prevents them from experimenting with independence, which can lead to frustration and even the testing of boundaries. They understand that it is important that they eat and may want to feed themselves to test your response. Feeding a child who can already sit also prevents them from experimenting with fine motor skills and textures.

Food as a power struggle

Food is a weak spot for many parents and can lead to many a power struggle with their children. When we fight for power with our children, all sides tend to come out losing; the parent because they ruined their relationship with their child and the child because they misunderstood something that caused them to behave poorly in order to receive attention.

If you look at all the elements related to introducing solids, you can reach many more, varied conclusions that digress from the norm to focus solely on early exposure as a means towards preventing allergies. From a nutritional perspective, the western world concurs that infants should ideally nurse for their first year of life, after which solids should be integrated (but without fully dropping nursing until age 2). Nutritionally speaking, breast milk is suitable as the near single source of nutrition for infants throughout their first year of life. An infant who only nurses won’t match Tipat Chalav’s (well-baby check-up clinic) growth charts, as they are based on infants who integrated solids into their daily diets at a younger age. On the other hand, infants do gain from the gradual exposure to other foods and their digestive systems will be strong enough to cope with them. They will be more mature and ready for the solids stage when it finally arrives, and the likelihood of resistance and power struggles regarding food will be lessened.

My suggestion includes a more comprehensive consideration of elements that the health system doesn’t base their research on - wait for the infant to be ready, not just from a perspective of exposure to allergens, but also from physiological, motoric and cognitive perspectives. When your infant is ready, they’ll be happy to switch over their nutrition and won’t want to just drink milk anymore.

Good luck and bon appetit!

The article’s author, Einat Dolev Hadas is a certified developmental and nursing consultant and owns the “Parents Online” studio in Modiin, home to many activities for parents and their children.