Solids in the first year /

When to start solids in normal infants and those at risk of allergies

01 In Brief

It is no coincidence that readiness for solids seems to align with accquisition of developmental skills needed, maturation of the digestive system and when breast milk or formula is no longer enough nutritionally. Advice regarding the optimal time to start solids has had a rethink in recent years.

02 What Do I Need To Know?


Every baby is different, some are ready earlier than others.

Signs your baby is ready, willing and able to take this next big step:

  • Interested in food, tends to watch you intently when eating and opens their mouth eagerly when food is offered
  • Able to swallow, food is not pushed forward when offered due to the tongue thrust reflex 
  • Able to coordinate eyes, hands and grabs food and puts it into their mouth
  • Able to hold head up high, good neck and head control is important as baby needs to sit upright 
  • Able to sit supported with some propping in a high chair and hold head steady.

A week or so before starting solids have a practice run. Put your baby in their new high chair watch their head control and let them play with a plastic spoon and bowl.


This is probably one of the most confusing areas for mothers as advice has significantly changed over the last 2-3 years, websites are out of date and not all experts agree.

The rethink about the optimal time to introduce solids relates to newly published data that suggests that early introduction of solids from 17 weeks to 7 months decreases the likelihood of development of food allergies especially if it is combined with breast feeding. A delay in introducing potentially allergenic foods as previously recommended may increase rather than decrease food allergies. More studies are in progress but recent findings from the HealthNut study from the Royal Childrens Hospital Melbourne Murdoch Research Intstitute would suggest that introduction of eggs and nuts at 5- 6 months decreases allergy to these foods.

The main high risk allergenic foods that account for more than 90 % of food allergies include cow's milk/ dairy, egg, soy, wheat, peanut, tree nuts, fish and shell fish.

There is also evidence that delayed progression to solids of increased variety and texture prediposes some children to fussy eating.

At around 6 months as the baby's stores of micronutrients diminish and breast milk is not able to supply sufficent iron and zinc. In some infants whose mother has borderline vitamin B12 levels, deficiency becomes a concern as B12 is essential for normal growth and brain development. The introduction of solids rich in theses micronutrients such as iron fortified cereals and meat is important. Delayed introduction of solids beyond 7 months will place the baby at nutritional risk.

Early introduction under 4 months is not advised as the infants gastrointestinal tract has not developed sufficent maturity to digest foods, there is evidence it increases food allergy and it is unsafe in view of the choking risks.


The National Health and Medical Reasearch Council, Australian Breast Feeding Association and the World Health Organisation support exclusive breast feeding and introduction of solids around 6 months.

The Australian Society of Clinical Immunology and Allergy ASCIA supports the introduction of solids between 4- 6 months when the baby shows signs of readiness.

The American Academy of Allergy, Asthma and Immunology have released the most recent guidelines for introduction of complementary solids and high risk allergenic foods, recommending that once the first foods such as cereals, fruit and vegetables are introduced and tolerated then allergenic foods should be introduced. One new food every 3-4 days, at home in small quantities that are gradually increased.

In children with poorly controlled eczema, history of food allergy or a strong family history of food allergy particualrly peanuts specialist medical advice is advised.

This is the Summary of recommendations from the AAAAI published January 2013

Introduction of complementary foods 

 •Complementary foods can be introduced between 4 and 6 months of age.

•There are no current data available data to suggest that cow’s milk protein (except for whole cow’s milk), egg, soy, wheat, peanut, tree nuts, fish and shellfish introduction into the diet need to be delayed beyond 4-6 months of age. Therefore, complementary foods may include the highly allergenic foods once a few other complementary foods are tolerated first.

•New data are emerging that suggest the early introduction of the highly allergenic foods may reduce the risk of food allergy.

•Highly allergenic foods are best first introduced at home, rather than at a day care or at a restaurant.

•If a patient has had an allergic reaction to a food, has difficult to control moderate-to-severe atopic dermatitis, or has an underlying food allergy, referral to an allergist for testing is recommended before introduction of the highly allergenic foods.

03 What Others Say

  • Australian Breast Feeding Association

Confused about when to introduce solids

  • Australian Society of Clinical Immunology and Allergy

Infant feeding advice

Allergy prevention

  • The Journal of Allergy and Clinical Immunology: In Practice Vol 1: 1 January 2013

Primary Prevention of Allergic Disease Through Nutritional Interventions

  • Joint statement Canadian Pediatric Society and the Canadian Society of Allergy and Clinical Immunology

Dietary exposures and allergy prevention in high risk infants

  • Centre for Community Child Health

Reducing the risk of developing food allergy


04 I Want To Know More

  • Guide for nutritious family meals for babies and toddlers: excellent guide on how to introduce meat 

How to make every bite count


05 Clinicians Tools and Resources

  • National Health and Medical Research Council, 2011 Australia: currently under public consultation

Draft Infant feeding Guidelines for Health Workers Guidance

Literature review for NHMRC


The information published here has been reviewed by Flourish Paediatrics and represents the available published literature at the time of review.
The information is not intended to take the place of medical advice.
Please seek advice from a qualified healthcare professional.
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Last updated: 10/11/2013 by Dr LIz Hallam