Introducing solids while you are still breastfeeding

The advice that gets missed most often about starting solids is the simplest one. For the first year, food is in addition to milk rather than instead of it. Parents are often surprised by how little their baby actually eats at first, and worry they are doing it wrong, when in fact very small amounts are exactly right.

When to start

The NHS advises waiting until around six months. That is not an arbitrary date. It gives your baby's gut and kidneys time to mature, gives them the coordination to handle food safely, and means breast milk has done its job through the period when it is most protective.

Three signs together tell you they are ready, and all three matter:

• They can sit up and hold their head steady.
• They can coordinate eyes, hands and mouth, so they can look at food, pick it up and get it to their mouth themselves.
• They can swallow food rather than pushing it back out with their tongue.

What is not a sign of readiness, whatever anyone tells you, is waking more at night, chewing fists, watching you eat, or being a big baby. All of those happen long before six months and they are normal.

If your baby was born prematurely, timing is worked out from their due date rather than their birth date, so ask your health visitor.

How breastfeeding fits alongside

• Milk first, food second, at the beginning. Offer a breastfeed and then food a little later, so your baby is not filling up on food instead of milk.
• Expect very little to be eaten for the first few weeks. Most of it will be played with, squashed and dropped, and that is how they learn.
• Milk feeds drop gradually, usually from around eight or nine months as food intake grows. Some babies drop feeds quickly, some barely at all.
• Milk remains the main source of nutrition until around a year. After that it is still valuable, just no longer the main event.
• Offer water in an open cup with meals once solids start.

What to give

Whether you spoon feed purees, do baby led weaning where your baby feeds themselves from the start, or mix the two, is a matter of preference. Babies do well on all of them. The mixture is what most families actually end up doing.

• Start with vegetables, including bitter ones like broccoli and spinach, so their palate is not set entirely on sweet things.
• Iron matters from six months, as your baby's own stores start to run down. Meat, fish, eggs, beans, lentils and fortified cereals all help.
• Allergens early and one at a time. Egg, peanut in a smooth form, dairy, wheat, fish and sesame among them. Current advice is to introduce them from around six months rather than delay, and to keep giving them regularly once introduced. Introduce one at a time so you know what caused any reaction. If your baby has severe eczema or a known food allergy, talk to your GP first.
• No added salt or sugar, no honey before a year, and no whole nuts before five.

What changes

• Nappies. Stools become firmer, darker and considerably more unpleasant. This is normal and catches everyone out.
• Feeds get shorter, or your baby becomes more distractible at the breast.
• Night feeds often continue, and starting solids does not reliably make babies sleep through, whatever you may be told.
• Some babies get constipated when solids start. More water, more fruit and vegetables, and keeping milk feeds up all help.

How a consultation helps at this stage

Most families do not need help starting solids, and I would say that plainly. The appointments I do see at this stage are usually about something else that solids have brought to a head. A baby who has started refusing the breast now food has arrived, a mother whose supply feels like it is dropping and does not know whether that is expected, someone going back to work and trying to work out how milk and food fit around the day, or a baby whose weight gain has slowed and it is not clear whether that is the solids or something else. Those are worth a proper look, and they are quicker to sort than they seem.