Infants need only breast milk or formula for their first 4 to 6 months. The most common question that parents ask their pediatricians and extended family members is "When should I start my baby on cereals, fruits, and vegetables". Many infants are ready for this step at 4 months. Others need to wait until they are 6 months. A baby who has been ill or has experienced difficulty eating may need to wait much longer. It all depends on the child. Babies give us cues that let us know when they are ready. This helps their parents identify the best time to introduce this new step in feeding. Babies who are ready learn quickly and are happier eaters than babies who need to wait a bit. Babies are their own experts in eating. They know when to move on to the next step. When your baby gives you the weight, physical, and sensory cues listed here, you can offer the first supplemental foods. Use ideas from this guideline to make learning to eat from a spoon as easy as possible for you and your baby. Observe your baby's mealtime communication, mouth, and learning cues during the first week to decide whether you'll continue to offer supplemental foods or whether you will wait for another week or two.

READINESS CUES

Weight Cues

The baby who is growing rapidly and always seems hungry may need extra calories from supplemental foods to support growth and satisfy hunger. Supplemental foods are foods fed in addition to the baby's regular diet of breast milk or formula.

• Weighs 13 lbs. and has doubled the birth weight.

Physical Cues

Physical cues tell us that the child is developing good control of the head and trunk which support mouth skills for eating.

• Holds the head up and supports weight on the forearms when lying on the tummy.

• Pushes up on the arms with straight elbows when lying on the tummy.

• Holds the head up while sitting on a lap. Adjusts the head and maintains head control when tipped slightly backward or forward.

• Back is straight in supported sitting on the lap. Sits with less assistance and reaches out for a toy.

[If your child has problems controlling the muscles of the body because of a physical disability, head and trunk support during eating will be provided by your body or a special chair. You don't have to wait to introduce spoon foods until these physical cues are present.]

Sensory Cues

The child is seeking important information about texture, and is developing an acceptance of objects in the front of the mouth. This prepares for the feeling of the spoon and new food.

• Puts hands in the mouth easily and frequently. Discovers variations in hand mouthing patterns, sometimes sucking a fist, sometimes a thumb, and sometimes several fingers and a thumb.

• Reaches for toys and brings them to the mouth. Likes the feeling of different types of toys in the mouth.

[If your child has physical problems bringing the hands to the mouth, you may help. Look for the child's response when fingers or toys are brought to the mouth.]

Mealtime Communication Cues

The child knows if he or she wants to eat and how much food is needed. Children who use these communication cues can guide the person feeding them.

• Uses non-verbal communication cues to say "yes" and "no" clearly during non-feeding activities such as diaper changes, bath time, or play.

• Says "yes" to the food. Uses non-verbal mealtime communication cues:
  • Leans the body toward the spoon and food.
  • Reaches for the spoon or the feeder's hand.
  • Looks at the food and smiles.
  • Opens the mouth and begins to suckle.
  • Makes happy sounds.

• Says "no" to the food. Uses non-verbal mealtime communication cues:
  • Turns the head and body away from the spoon and food.
  • Looks down or plays with food on the highchair tray.
  • Pushes the spoon or the feeder's hand away.
  • Looks distressed or unhappy.
  • Closes the mouth tightly as the spoon approaches.
  • Cries.

Mouth Cues

When the child has developed the type of tongue pattern necessary for moving food to the back of the mouth and swallowing eating is much easier.

• Opens the mouth easily when the spoon approaches or touches the lips.

• Keeps the tongue inside the mouth when the spoon enters.

• Uses a rhythmical forward-backward suckle motion of the tongue as the food enters the mouth.

• Food stays inside the mouth and is not constantly "recycled".

• Draws in the bottom lip

  Babies go through a period of learning to eat solids just as they need time to learn any new skill. You can enhance your baby's abilities in each of the eating readiness areas. The following suggestions will help this learning period be easy and successful for both of you.

  Food Selection Guidelines

  • Single-grain infant cereal is often the first starting food fed after breast milk or formula. Rice cereal is ideal because it is likely to be well tolerated by your baby and is iron-fortified. At the beginning, mix the cereal with breast milk or formula.
    
    
  • Other single-ingredient solid foods and fruit juices can be added in the order your pediatrician or dietitian suggests until your baby is eating a variety of foods. These starting foods should have texture, nutrients, and flavor suitable for infants.
    
    
  • These starting foods should be added one at a time at intervals of three to four days. You can watch for signs (such as a skin rash) that the food might not agree with your baby.
    

  Physical Guidelines

  • A good body position will make it easier for your baby to relax and use good mouth control. Support your baby in a secure upright or slightly reclined position on your lap.
    
    
  • Because it takes more physical control to hold the head up while eating from the spoon, you should begin with your baby's body slightly reclined to make first learning easier. Provide head support with your body or a pillow if your baby wants to lean back.
    
    
  • When your baby keeps most of the food in the mouth, you can use an adjustable infant seat for more upright supported sitting. If your baby can sit without much support, you can use a high chair.
    

  Sensory Guidelines

  • Encourage and enjoy the times your baby sucks the hands and discovers fingers in the mouth.
    
    
  • Choose toys for your baby that have been safely designed for infants. These toys should be easy to hold in tiny hands. Think about the different mouth sensations that a toy can provide. Consciously select toys that provide many different sensations.
    
    
  • Remember that your baby is constantly learning from everything that goes in the mouth. The mouth is the most sensitive and intelligent part of the baby's body for first learning. The baby learns about important sensations such as shape, texture, and firmness by putting fingers, toes, blankets, pacifiers, and infant toys in the mouth. This information prepares the mouth and provides readiness for the new feelings of a spoon and different foods.
    
    
  • When you start new foods, begin with small tastes that your baby can suck off your finger, hands, or a pacifier. It's much easier for the baby to get used to new tastes first before learning to suck and swallow a mouthful of the new food.
    
    
  • Make slight changes in the thickness or thinness of the cereal. Many babies learn to eat more easily if the cereal is very thin. Others do better when it is thicker. Find just the right consistency for your individual baby. Remember that as your baby develops and eating becomes easier, a different consistency may be needed. You can also make infant fruits and vegetables thinner by adding juice or water, and can thicken them with rice cereal.
    
    
  • Introduce the first taste of fruit by mixing infant juice with a favorite cereal. Apple juice mixed with cereal prepares for the new taste of applesauce. Pear juice with cereal makes the transition to pears easier.
    

  Mealtime Communication Guidelines

  • Listen! Recognize and remember the non-verbal ways your baby communicates needs and desires.
    
    
  • Your baby should always be the leader. When your child says "no", or "no more", the feeding should stop. When the baby says "yes", offer more food and enjoy your mutual delight and exploration of the meal.
    
    
  • When mixed "yes-no" messages occur, make small changes to find out what part of the meal your baby doesn't like. You might reposition the baby for greater physical comfort, offer a more familiar food, change the temperature of the food, or return to the bottle or breast.
    
    
  • Resist the temptation to get your baby to take "just one more bite" or finish the jar of baby food.
    

  Mouth Guidelines

  • Encourage a rhythmical in-out suckle movement of the tongue. Gently stroke the lips with the spoon to get the suckling movements started before you put a small amount of the food in the mouth. Don't dump food on a quiet tongue. Let your baby use movement to bring the food into the mouth.
    
    
  • As your baby becomes more experienced, the mouth will open and the tongue will be quieter as you present the spoon slowly. When you put the spoon in, the top lip will come down on the spoon to help bring the food in.
    
    
  • Allow enough time between spoonfuls so that your baby can adjust the mouth and signal for the next one.
    
    
  • If your baby has trouble developing a good suckling rhythm with the spoon, you can use an orthodontic pacifier as a first spoon. If the baby has been using this type of pacifier, a strong suckle pattern naturally follows when it is placed in the mouth. Dipping the pacifier in cereal may allow the baby to generalize a suckling movement to food. Gradually introduce the spoon again when your baby is ready.
    
    
  • Many babies will spontaneously put their hands in the mouth and suck their fingers along with the food. Even though it may be messy, your baby has discovered a wonderful way to learn to suck and swallow the food more quickly.
    

  Learning Guidelines

  • You can help your baby learn to eat supplemental foods more easily and with greater enjoyment when you are calm and relaxed. Sit with the baby in a rocking chair and play soft, relaxing music to create a relaxed atmosphere for both of you. Remember that your initial goal is to help your baby learn and enjoy a new skill. It doesn't matter how much or how little food is actually eaten at this time.
    
     
  • Give some formula or breast milk first so that your baby is not extremely hungry when you try the new food. Babies are impatient when they are very hungry and may not want anything new. Your child's motivation and interest in new tastes and foods will be much higher after the first hunger is satisfied.
    
    
  • Follow the suggestions given in the physical, sensory, and mealtime communication areas. These will enhance your baby's readiness and make it easier to learn the new skill of eating supplemental foods.
    
    
  • Encourage tasting and eating the food, but don't force your baby to continue; stop when the child tells you "no more". Conclude the meal while everyone is still feeling happy and successful. Finishing on a positive note will ensure that the next mealtime is just as pleasurable and successful.
    
    
  • Let your baby know you are delighted with this new learning. Be supportive and encouraging even if it is initially difficult.
    
    
  • If your baby doesn't enjoy the new eating experience or if you are constantly recycling the same spoonful of food, put the food away and try again next week. Remember there is a wide variation in eating readiness, and only your baby knows when the time is right. Respect your baby's innate knowledge, and remind yourself that waiting for another week (or month!) does not mean that either of you has failed. You have both succeeded in communicating readiness and respect to each other. If you trust your baby's physical and emotional signals of readiness, you will find exactly the right time for introducing supplemental foods so that both you and your baby can enjoy this new accomplishment.
    
    
  • A baby or young child who experiences problems with postural tone and movement may experience added challenges in learning to eat from a spoon. These guidelines will give you many good ideas in helping all children learn to eat soft solid foods from a spoon. However, some changes or modifications will be needed if your child has a physical or sensory feeding problem.
    

  Suzanne Evans Morris, Ph.D.
  Speech-Language Pathologist
  New Visions
  1124 Roberts Mountain Road
  Faber, Virginia 22938
  (804)361-2285

  This paper is a working draft and multiple copies may not be reproduced
  without prior written permission of the author
  © Suzanne Evans Morris, 1997 All Rights Reserved