Complementary feeding from 6 to 12–18 months: what to offer and when

When should you start complementary feeding?

The Spanish Association of Paediatrics recommends starting at 6 months for breastfed babies, while continuing breastfeeding on demand [1]. Whatever milk your baby has, do not start before 17 weeks or after 26 weeks [2]. Age is a guide, but your baby’s readiness is what matters [1].

There are four signs that your baby is ready [1]: active interest in food; loss of the tongue-thrust reflex, which pushes out anything that is not liquid; picking up food and bringing it to the mouth; and sitting upright with support. If unsure, ask at the 6-month paediatric check-up. Readiness is assessed individually for premature babies; around 6 months’ corrected age is often used as a guide [1].

Is there an order for introducing foods?

No. There are no “best” first foods, and rigid instructions should not be given, according to the Spanish Association of Paediatrics [1]. You can start with vegetables, fruit, cereals, pulses, meat, fish or egg, depending on your family’s usual meals.

There is one priority: iron. The risk of iron-deficiency anaemia rises from the sixth month, so offer meat, egg yolk, pulses or iron-fortified cereals every day [1]. Our guide to anaemia and iron-rich foods has ideas for each group. Introduce new foods one at a time, leaving a few days between each so you can observe tolerance [1].

When should you introduce gluten and allergenic foods?

Do not delay them. There is no evidence that waiting beyond 6 months prevents allergy, whether or not your baby is at risk of atopy [1]. ESPGHAN agrees these foods can be introduced when complementary feeding begins [2]. Offer egg, fish, pulses and ground nuts one at a time, like other foods.

Gluten should be introduced between 4 and 11 months, ideally around the sixth month and in small amounts at first [1], such as a small piece of bread or a few spoonfuls of pasta or oats. Egg should always be thoroughly cooked, boiled or as a fully set omelette. Offer each new food during the day so you can observe tolerance.

Moving from purées to lumps and pieces

Move on early. The Spanish Association of Paediatrics recommends gradually increasing texture and offering lumpy foods as soon as possible, and no later than 8–9 months [1]. Introducing lumps after 9 months has been associated with longer-term feeding difficulties and lower fruit and vegetable intake [1].

If you start with purées, move quickly from smooth purée to food mashed with a fork. At around 9 or 10 months, once your baby can pick things up between finger and thumb, they can handle soft pieces that squash easily. From their first birthday, they can eat the family’s foods, taking care with choking hazards [1]. Our baby-led weaning guide explains how to start safely. See “When to give a baby water and how much they need”. See “What can a 9-month-old baby eat”.

When can a baby drink cow’s milk?

As a drink, from 12 months [1] [2]. Until then, breast milk or infant formula is your baby’s main food. The Spanish Association of Paediatrics recommends continuing breastfeeding on demand, without reducing feeds [1], and breastfeeding can continue until age 2 or beyond [3]. If your baby has formula, use follow-on formula from 6 months. Aim for at least two dairy servings a day, around 500 ml [1]. Do not insist on purées if this means your baby drinks less milk.

Before their first birthday, cow’s milk can displace breast milk or formula and provides little iron. Plain yoghurt and mild cheese can be introduced in small amounts from 9 months [1]. Between 12 and 18 months, whole milk can be part of meals without displacing other foods. Our breastfeeding guide answers common questions.

What should a baby not eat before their first birthday?

There are three reasons to wait: choking risks, contaminants and foods with little nutritional value. Wait until after 12 months to offer honey, sugar, cocoa, pastries, biscuits and cured meats; later and in smaller amounts is better [1]. Honey may contain Clostridium botulinum spores, which cause infant botulism, so AESAN advises against giving it before their first birthday [4].

Do not offer whole nuts, popcorn, whole grapes, sliced sausages, or raw apple or carrot, because of choking risk [1]. Avoid whole nuts or pieces until age 5; from the start of complementary feeding, serve them ground or as nut butter [1]. Do not add salt, as a baby’s kidneys are not ready to handle it [1].

Children under 10 should not eat swordfish, red tuna, shark (dogfish, blue shark) or pike due to mercury [5]. During the first year, avoid leafy greens high in nitrates, such as chard, spinach and borage. If included, they should make up less than 20% of the meal [1].

If your baby refuses food

Respect your baby’s cues. WHO recommends responsive feeding: feed patiently, without forcing or distracting, and respond to hunger and fullness cues [3]. Adults decide where, when and what is offered; the baby decides how much to eat [1]. Forcing, pressuring or rewarding interferes with a child’s own sense of fullness [1].

A refusal is not final. It can take 10 to 15 tries for a baby to accept a new food [1]. Take it away without making a fuss and offer it again another day, prepared differently. If your baby does not eat, stay neutral.

What common difficulties do we see in appointments?

Three situations come up almost every week when we see families with babies this age.

• Sticking with smooth purée for too long. Fear of choking can mean purées continue until 10 or 11 months. After that, accepting lumps can be harder.
• Counting spoonfuls. Keeping track of how much your baby eats creates tension. At this stage, variety and continuing to drink milk matter more.
• Mistaking gagging for choking. Gagging is noisy and part of learning to chew. Choking is silent and requires immediate action.