Introduction



One of the most important and challenging stages in a baby’s development is the introduction of solid foods and the weaning from breast milk. How can parents know if their child is ready to start complementary feeding (CF)? How should it be done correctly? Are there foods that should be avoided?

To clarify these and other questions, we spoke with Nurse Diana Semião-Lobo, Specialist in Maternal and Obstetric Health, Lactation Consultant, and Expert in Participatory Feeding Introduction and Baby-Led Weaning, and Dr Ema Monteiro, Nutritionist specialising in Maternal and Infant Health.



When to Start Complementary Feeding



The World Health Organization (WHO) recommends exclusive breastfeeding up to 6 months of age, as it is one of the most effective ways to ensure a child’s health¹. Starting complementary feeding before 6 months may lead to risks such as diabetes, hypertension, obesity, allergies, and intolerances.



“We still live in a country that encourages early complementary feeding far too often — sometimes on the grounds that the baby is starting nursery or the mother is returning to work. Beginning complementary feeding before the right time increases the risk of future health problems such as diabetes, hypertension, obesity, coeliac disease, allergies, intolerances, dermatitis, among others. Unfortunately, these risks are rarely discussed with parents during the 4-month check-up. Moreover, there is little guidance on how to maintain exclusive breastfeeding when the mother returns to work, which doesn’t help.”



Before starting CF, it’s important to ensure that the baby’s body is ready — and to give them the opportunity to show it freely.



Signs That the Baby Is Ready



Can sit up and hold their trunk with minimal support

“If they don’t yet have this ability, they will use up a huge amount of energy trying to stay upright and won’t be able to focus on what they are doing with food. Proper posture is essential for the gag reflex to work effectively and prevent choking.”



Starts bringing objects to their mouth

“This can be encouraged through teethers, which help babies practise hand-eye-mouth coordination and develop orofacial muscles.”



Makes chewing movements

“This is essential to break food into smaller pieces before swallowing, ensuring safety.”



Shows interest in food

“This readiness sign is often mistaken for curiosity. Babies are naturally curious and love to observe.”



Just like other developmental milestones — walking, crawling, or talking — CF needs time, space, and individual signals.



“Babies start rolling over, crawling, sitting, standing, and walking when they’re ready. What do we usually do? We put them on a mat, give them space and let them move freely. We adjust the environment and introduce toys as they grow, only helping when needed. So why do we do it differently with food? Why do we set a date for them to start eating?”



Feeding Methods



There are three possible approaches:



Traditional or Parent-Led Weaning – the adult sets a start date for feeding, usually under medical guidance. Parents are encouraged to reduce milk intake and introduce food gradually.



Responsive or Baby-Led Weaning – the baby leads the process, with parents responding to their cues. Parents trust the baby’s abilities and respect their autonomy.



Mixed Approach



“We should start being more responsive and respectful of the baby’s development. Seeing them as helpless and giving them a completely passive role can harm their physical and emotional growth.”



What to Offer in the First Meals



There are no strict rules.



“The order of introducing foods is purely cultural.”



From 6 months onwards, all food groups can be offered — vegetables, grains, meat, fish, and eggs — and parents can decide the order.



It is recommended that the baby’s plate include:



A high-energy food (calorie-dense)



A source of iron, animal or plant-based (combined with vitamin C to enhance absorption)



One or more fruit or vegetable foods (source of vitamins and minerals)



Foods to Avoid



Two types of foods should be avoided — either for nutritional reasons or because of choking hazards (unless properly prepared).



Avoid for nutritional reasons:



Sugar, sweets, and artificial sweeteners



Cow’s milk as a drink (can be used in recipes)



Undercooked fish, meat, or eggs



Rice drinks



Added salt in meals



Fruit juices



Fizzy drinks



Honey



Teas



Avoid for choking risk:



Hard, raw, or whole fruits and vegetables (e.g. apple, carrot)



Whole nuts



Thick pastes not spread (e.g. peanut butter)



Tough meats or those with small bones



Fish with skin and/or bones



Hard cheese



Sausages and similar foods with suction effect



Loose fruit skins



Large seeds or pits



Popcorn



Should Allergenic Foods Be Delayed?



Recommendations have changed significantly in the last decade. It is now known that introducing allergenic foods between 6 and 9 months is key to preventing allergic reactions — or at least reducing their severity.



Reference Quantities



Scientifically, there is no evidence of an ideal portion size. Each baby has different nutritional needs based on their energy, height, stomach capacity, and appetite.



“We must be careful with how much we put on a baby’s plate — that amount reflects the adult’s expectation, not the baby’s. It’s better to start small and add more as long as the baby shows interest. Babies are born knowing when they’re full — we see this with breastfeeding on demand. CF should be no different: we must trust and teach the baby to respect their satiety cues.”



Acknowledgement



A special thank you to Nurse Diana Semião-Lobo and Dr Ema Monteiro, specialists from the Little Humans – Parenting, Health and Wellbeing Support team, for their valuable collaboration.



References



¹ Breastfeeding. (n.d.). World Health Organization (WHO).