Starting solids at six months from an Indian kitchen

Start solid foods at around 6 months, when your baby can sit with support and shows interest in food, and keep breastfeeding alongside. Your own kitchen already has excellent first foods: thick khichdi, dal, ragi, egg, fish and mashed fruit. Move on to lumps and finger foods within a few months. Give peanut and egg early, and skip salt, sugar and honey before the first birthday.

When should my baby start solid food?

At around 6 months. Indian and WHO guidance both advise exclusive breastfeeding for 6 months, then adding other foods while breastfeeding continues.^1,2

Around this age, breast milk alone stops covering all of a baby's needs, especially for iron. Her gut is ready for new foods, and her mouth and body are ready to handle them.

Solids should never start before 4 months, and should not be delayed much beyond 6 months.³ If your baby was born preterm, ask your doctor. The start is usually guided by her corrected age and readiness.

In Bengali homes the annaprashan (mukhe bhaat) often sets the date. Dr Dutta loves the ceremony. Just treat it as the start of a slow change in diet, not a one-day event, and keep going with real meals the next week.

How do I know my baby is ready for solids?

Look at your baby, not only the calendar. A ready baby can hold her head steady, sit with support, and shows interest in your food.

• She holds her head and neck steady.
• She can sit upright with some support.
• She watches you eat and reaches for your plate.
• She opens her mouth when a spoon comes close.
• She no longer pushes every bit of food straight out with her tongue.

Waking more at night or chewing her fists are not reliable signs. Babies do both at many ages.

What are the best first foods for an Indian baby?

Thick, soft, home-cooked food that includes iron-rich items. Every baby should get iron-rich foods such as egg, meat, fish or fortified foods from the start.³

• soft khichdi of rice and moong dal, well mashed, with a little ghee
• ragi porridge, cooked well
• suji or dalia cooked in water or breast milk
• mashed banana, stewed apple, ripe papaya, boiled potato or sweet potato
• pumpkin, carrot, lauki or palak mashed into dal or rice
• well-cooked egg
• soft, carefully deboned fish such as rui or bhetki, mashed into rice
• minced or very soft chicken in khichdi

Offer bitter greens too, not only sweet fruit.³ Babies learn to like what they see often. You do not need packaged baby cereals.

Is dal water or rice water good for my baby?

Not as a main food. Thin liquids such as dal ka paani, rice water and watery soups fill a small stomach with very little energy or iron.

This is the most common mistake Dr Dutta sees. A simple test: the food should be thick enough to stay on the spoon when you tilt it. Mash the dal itself, not just the water it was cooked in.

A teaspoon of ghee or oil in your baby's food adds useful energy. Thick khichdi with mashed vegetables and a little ghee is far better than a bowl of thin soup.

How much and how often should my baby eat solids?

Start with a few spoonfuls once or twice a day, and let your baby lead. Breast milk stays her main food in the early months of solids.

Over the next few months, build up to about three meals a day, and by the first birthday add one or two healthy snacks. Her portions will grow as her appetite does.

Keep breastfeeding as often as before. The IAP advises continuing breastfeeding up to 2 years and beyond.¹ Solids are added to milk feeds, not swapped for them.

Some days she will eat a lot, some days very little. Growth over weeks matters more than any one meal.

When should my baby move from puree to lumpy food?

Bring in soft lumps by about 7 to 8 months, and certainly before 9 months. Babies who first get lumpy food after 9 months tend to be fussier eaters later.⁴

A large UK study of about 7,800 children found that those who first had lumpy food after 9 months ate less fruit and vegetables at age 7 and had more feeding problems.⁴ Chewing is a skill learned with practice, and there seems to be a good window for it.

• 6 to 7 months: thick, smooth or lightly mashed food.
• 7 to 9 months: mashed with soft lumps, plus soft finger foods.
• 9 to 12 months: chopped family food and more finger foods.
• By 12 months: most family foods, less spicy and cut small.

What finger foods can I give my baby?

Soft foods your baby can grip and squash between your finger and thumb are good first finger foods.

• a steamed carrot or beans stick
• a soft piece of idli or dhokla
• a strip of soft chapati or paratha
• a slice of ripe banana or papaya
• a soft piece of paneer
• a well-cooked piece of egg

Finger foods let her practise chewing and feeding herself. Expect mess. Most of the first few weeks of food ends up on the floor, and that is part of learning.

What is baby-led weaning, and is it safe?

Baby-led weaning means letting your baby feed herself soft finger foods from the start, instead of being spoon-fed purees. Done with care, it does not seem to raise the risk of choking.⁵

In a trial of 206 babies in New Zealand, babies who fed themselves, with advice on choking risks, did not choke more often than spoon-fed babies.⁵ But in both groups many babies were offered risky foods.⁵

You do not have to choose one method. Many Indian families mix the two: spoon-fed khichdi plus a soft piece of chapati to hold. Whatever you do, make sure some foods are rich in iron, and keep foods soft enough to squash.

What is the difference between gagging and choking?

Gagging is noisy and normal: your baby coughs, splutters and pushes food forward. Choking is silent: she cannot cough, cry or breathe, and needs help at once.

Gagging is a safety reflex. It moves food back to the front of the mouth and is common in the first weeks of solids. Stay calm and let her sort it out.

To reduce the risk of choking:

• Always seat her upright, and stay with her while she eats.
• Never feed her lying down, in a moving car, or while she is crawling about.
• Avoid whole nuts, whole grapes, popcorn, raw hard carrot, hard chunks of fruit and fish with bones.
• Cut round foods such as grapes into quarters, lengthwise.

If you can, learn baby first aid for choking. Many hospitals in Kolkata run short courses.

When can my baby eat peanut and egg?

Once solids have started, from around 6 months. Giving peanut and egg early lowers the chance of allergy to them.^6,3

In the LEAP trial, babies at high risk of peanut allergy (with severe eczema, egg allergy or both) were given peanut regularly or kept away from it until age 5. Among those who had no reaction on a skin test at the start, peanut allergy at 5 years was 1.9% in the eating group and 13.7% in the avoiding group.⁷

A review of trials found that giving egg at 4 to 6 months, and peanut at 4 to 11 months, was linked with less allergy to these foods.⁶

If your baby has severe eczema or a known food allergy, talk to your paediatrician first. Some babies need checking before peanut is started.³

How do I give peanut and egg safely?

Give peanut as smooth peanut butter thinned with water or milk, or as fine peanut powder stirred into porridge. Never give whole or chopped nuts to a baby.

• Start with a small amount on a day when she is well and you can watch her for a couple of hours.
• Cook egg until fully set. No runny yolk or raw egg.
• Once a food is in her diet, keep giving it a few times a week. Dropping it again may lose the benefit.

Signs of a reaction include hives, swelling of the lips or eyes, repeated vomiting, or noisy breathing. Breathing trouble needs emergency care straight away.

Can I add salt, sugar or masala to my baby's food?

Do not add salt or sugar to your baby's food in the first year, and avoid juices and sweet drinks.³

Take your baby's portion out before you add salt to the family pot. Papad, pickles, chips, namkeen and stock cubes are all very salty. Biscuits, sweet cereals, packaged juice and mishti at family functions add sugar she does not need and shape her taste for life.

Mild spices are fine in small amounts. A pinch of jeera, haldi or hing in dal adds flavour without harm. Keep chilli out until she is older.

Why is honey not safe for babies under one year?

Honey can carry spores of the germ that causes botulism, a rare but serious illness in babies. Do not give honey in any form before 12 months.⁸

In a baby's young gut, the spores can grow and make a toxin.⁸ This causes constipation, a weak cry, poor feeding and floppiness that gets worse.

That means no honey in food, no products made with honey, none on a dummy, and none as a first taste at birth or at the annaprashan.⁸

When can my baby have cow's milk, curd or tea?

Curd and a little milk in cooking are fine from 6 months, but cow's or buffalo milk should not be her main drink before 12 months.³

Cow's milk is low in iron, and its calcium and protein reduce how much iron the body absorbs. In young babies it can also cause tiny, unseen blood losses from the gut.⁹ All of this adds up to iron deficiency, which is very common in Indian toddlers.

Tea and coffee have no place in a baby's diet. Tea also reduces iron absorption from food.

Breast milk, or formula if she is not breastfed, remains her main milk until her first birthday. Offer small sips of water from an open cup with meals.

How do I know if my baby is hungry or full?

Watch her. A hungry baby leans forward and opens her mouth. A full baby turns away, closes her mouth or pushes the spoon off.

European guidance advises parents to respond to these hunger and fullness signals, and not to use food to comfort or reward.³

Many grandmothers believe a good baby is a well-filled baby. Dr Dutta would rather the baby learned to stop when full. Do not force the last spoonfuls. Keep phones and television away at mealtimes, because babies eat on autopilot in front of screens. Eat together when you can, so she sees you enjoy the same food.

When should I talk to a doctor about my baby's eating?

Call emergency services or go to hospital if your baby has trouble breathing, swelling of the face or lips, or becomes floppy after eating a new food.

See your paediatrician if:

• she gets hives or repeated vomiting after a new food
• she is losing weight, or falling across the lines on her growth chart
• she still cannot manage any lumps by 9 to 10 months
• she coughs or splutters with almost every meal
• she refuses all solids for weeks
• she has severe eczema, was preterm, or has a medical condition, and you have not yet started solids