INTRODUCING SOLIDS TO PREMATURE BABIES – JANUARY 2019 PAGE 1 OF 3
Choosing the right time to introduce solids to premature babies can be confusing. In this fact
sheet we explain what you need to consider when introducing solids to your premature baby.
When to start?
Premature babies have different nutrition needs to
term babies. The current guidelines suggest starting
solids at around six months in full-term babies.
However, this is not the same for premature babies.
Introducing solids before your baby’s digestive
system is ready may increase the risk of allergy.
If solids are started too late, your baby may be
reluctant to accept new foods. There is also the risk
of anaemia as the baby’s iron stores run low.
Based on limited available evidence, a corrected
age of three months (the age from the expected due
date) is the appropriate time to consider the
introduction of solids for premature babies. The
latest time to start is around seven months of actual
age (their age from birth or uncorrected age).
As a general rule, most healthy premature babies
will be ready to start solids between five and seven
months (uncorrected age). The exact time within
this two-month time period will depend on your
baby’s gestational age, developmental progress and
when they show signs of readiness. For example, a
baby born at 23 weeks might be ready to start solids
at seven months uncorrected age whereas a baby
born at 36 weeks may start at five months.
Signs of readiness
Before starting solids, your baby should show at
least some of the following signs:
•
Can sit in a supported position on your lap,
bouncer or high chair.
•
Can hold his or her head in a stable position.
•
Often puts hands or toys into their mouth.
•
Leans toward a spoon or food when it is offered
and opens their mouth.
How to start?
Your baby will enjoy watching others eat. Shared
meals with friends and family will help your baby
learn about mealtimes.
When feeding, place your baby in a secure, upright
position, so they can take food easily. It is okay to
start by feeding baby on your lap; however, using a
bouncer will allow you to make eye contact with
your baby. Later on, place baby in a highchair with a
tray or a seat that attaches to the table so they can
feed themselves with their fingers.
Make meal times pleasant. Choose a time for
starting solids when you and your baby are happy
and relaxed, such as mid-morning after a nap. In the
beginning, offer solids after a breastfeed or formula
so your baby is not too hungry.
Use a small plastic teaspoon and put the food in the
middle of your baby’s tongue. Start with one or two
teaspoons and gradually build up the amount.
A lot of babies spit out food when it is offered for the
first time. If your baby becomes upset or frustrated,
stop and try again in a few days.
Playing with food is an important part of learning; so
prepare your baby and yourself for a bit of mess.
Using a clean, plastic sheet on the floor can be
helpful especially when your baby starts finger food.
First foods
Foods should be smooth and creamy with no lumps.
Try one new food every two to three days.
Suggestions for nutritious first foods to offer your
baby include:
•
iron-fortified infant cereals
•
pureed meat, chicken, fish, egg, beans/lentils or fish
•
pureed ripe avocado, apple, banana, potato,
sweet potato (choose one or two at a time).
INTRODUCING SOLIDS TO
PREMATURE BABIES
INTRODUCING SOLIDS TO PREMATURE BABIES – JANUARY 2019 PAGE 2 OF 3
Introducing more foods and textures
During the first few months of eating solids, breast
milk or infant formula will continue to be your baby’s
major source of nutrients.
Within one to two weeks or when your baby is
taking two to three teaspoons at a meal, you can
start to offer another meal at a different time of day.
Continue to offer iron-containing foods, more variety
of fruit and vegetables, plain yoghurt and cow’s milk
on cereal or in cooking.
About one month after starting solids:
•
Offer three solid meals per day
•
Introduce a cup for drinking (cooled, boiled water)
•
Add in soft finger foods and finely minced foods
About two months after starting solids:
•
Offer solids before a breast or bottle feed
•
Introduce cut up soft, minced or mashed food with
small, soft lumps such as minced meat, egg or
cooked lentils
•
Offer other foods such as bread, pasta,
dissolvable crackers, fine porridge, quinoa, rice
and cheese
Your baby will be able to chew soft food even if they
do not yet have teeth. They may cough or gag a
little when starting lumpy food. This is a normal
reaction for many babies trying new textures. Lumpy
food should be introduced by nine months of age
(from their date of birth) at the latest.
As with full-term babies, the later a premature baby
is introduced to new tastes and textures the less
likely they are to accept them. Babies need to
explore, touch and taste new food at their own pace.
Offer your baby a spoon at mealtimes even if you
continue to feed them with another spoon. Start
giving your baby finger food and offer different
flavoured foods separately so they can distinguish
between them.
Keep offering a variety of food to your baby so that
by around one year of age they are eating all the
usual family food.
If your baby is formula-fed, full cream cow’s milk can
be substituted for their main drink after 12 months
corrected age. Limit milk to 500mls in total per day to
ensure your toddler remains willing to eat solid foods.
Home-made vs commercial baby foods
Use homemade foods as often as possible. Shop-
bought jars or pouches of baby foods can be useful
when out and about but they do not teach your baby
about the taste of individual foods. They are also
more expensive and can contain less protein than
home cooked meals.
Eating Issues
Food refusal
Respond to your baby’s cues and don’t try to force
them to eat. Babies may refuse food for many
reasons, such as if they are unwell, tired or teething.
Keep meal times to no longer than 30 minutes
otherwise your baby may become restless and lose
interest.
Signs that your baby has had enough include:
•
closing their mouth
•
pushing the spoon away or spitting food out
•
turning their head away
•
getting upset or crying.
Between five to eight months old, babies are usually
willing to try new flavours but can become more
reluctant as they get older. Offering new foods twice
a week for at least five weeks will often lead to
acceptance.
Difficulty moving from smooth to lumpy textures
Some babies born prematurely have difficulty
accepting lumpy food, particularly if they had a long
period of tube feeding. Try introducing lumpy food
gradually by increasing the thickness of purees and
slowly introducing soft lumps such as ripe mashed
banana or avocado.
Aim to give your baby food that has an even
consistency. For example, avoid smooth purees
with floating lumps (common in commercial
pouches) as the mixed textures may make your
baby gag or choke. Giving your baby home-cooked
food makes it easy to control the consistency.
Another way to introduce lumps to a reluctant feeder
is by offering finger foods. Babies enjoy finger food
as it gives them more control over what they eat.
INTRODUCING SOLIDS TO PREMATURE BABIES – JANUARY 2019 PAGE 3 OF 3
Finger foods to try:
•
Ripe, peeled soft fruit such as banana, pear and
watermelon
•
Well-cooked, soft vegetables such as carrot,
zucchini, pumpkin and broccoli
•
Buttered toast fingers
•
Well cooked pasta shapes
•
Slices of cheese
Low food intake
In most cases, healthy premature babies will eat
when they are hungry. It is important to offer a
range of foods from the different food groups to
ensure a balanced diet. Some premature babies
can develop feeding problems, particularly those
with long-term health problems.
If you’re concerned about your baby’s growth or
eating skills, seek the help of a maternal and child
health nurse, paediatric dietitian or speech
pathologist.
Family foods
Your baby will gradually shift from mashed foods to
chopped family foods by around 12 to 18 months.
Avoid salty processed foods and adding salt to
cooked foods.
Offer your baby water at meal times to encourage
them to drink from a cup from about six months
corrected age.
Allergies
Premature babies have the same risk of developing
food allergies as babies born at term, so there is no
reason to delay introducing solids or particular
foods. In fact, introducing new foods to your baby
while breastfeeding may reduce the risk of
developing food allergies.
The importance of iron for premature
babies
Babies born prematurely have lower iron stores than
term babies and a higher risk of iron deficiency and
anaemia. Iron is needed to make red blood cells,
which carry oxygen around the body. It also plays a
role in immunity, brain development and growth.
Include iron-rich foods early in the introduction of
solids.
The best sources of iron are:
•
Red meat (beef, lamb, liver)
•
Chicken, pork and fish
Foods containing moderate amounts of iron include:
•
Iron-fortified breakfast cereals (such as baby
rice/porridge, wheat biscuits)
•
Lentils or legumes
•
Eggs
•
Leafy green vegetables
If your baby is prescribed iron and Vitamin D
supplements at discharge, continue these until
solids are well established or until 12 months of age.
For more information
Maternal & Child Health Line (24 hours)
T: 13 22 29
References
•
British Association of Perinatal Medicine 2011
Joint Consensus Statement on Weaning Preterm
Babies.
•
Bliss: for babies born premature or sick 2017
‘Weaning your premature baby’ (online)
https://www.bliss.org.uk/parents/about-your-
baby/feeding/weaning-your-premature-baby
•
Cormack, B, 2013 ‘Section 2: Preterm Baby
Feeding’ in Infant Nutrition Handbook 4th Edition,
Auckland District Health Board, Auckland
•
Palmer, D.J, Makrides, M 2012, ‘Introducing Solid
Foods to Preterm Infants in Developed Countries’
in Annals of Nutrition & Metabolism, No. 60 (Suppl
2), pp. 31–38
DISCLAIMER This factsheet provides general information only. For specific advice about your baby or your healthcare needs, you should seek advice from your health professional. The
Royal Women’s Hospital does not accept any responsibility for loss or damage arising from your reliance on this factsheet instead of seeing a health professional. If you or your baby
require urgent medical attention, please contact your nearest emergency department. © The Royal Women’s Hospital 2015–2019
