Synopsis
Support families to introduce varied safe foods from around 6 months while breast milk or first infant formula remains central, recognise developmental readiness, introduce allergens safely, progress textures, prevent choking and nutritional deficiency, and respect cultural and family preferences.
- Introduce complementary foods at around 6 months when the infant can remain seated with steady head control, coordinate eyes, hands and mouth, and swallow food rather than push it out.
- Do not use night waking, fist chewing or wanting extra milk alone as readiness signs. Avoid routine solids before 4 months; seek individual advice for preterm or developmentally delayed infants.
- Breast milk or first infant formula remains the main drink through the first year. Follow-on formula is unnecessary, and unmodified cow's milk should not be the main drink before 12 months.
- Start with small responsive tastes and progress promptly through mashed, lumpy and finger foods. Texture variety before about 9 months supports oral skill development; gagging is noisy and different from silent choking.
- Offer an iron-rich food daily, such as meat, fish, egg, beans, lentils, tofu or iron-fortified cereal, paired with vitamin C-rich food for plant iron.
- Introduce common allergens one at a time in small amounts from around 6 months; once tolerated, keep them in the diet regularly. Do not delay egg or peanut without a clinical reason.
- Infants with severe eczema or an existing food allergy need clinician-led advice before peanut or egg introduction, but blanket avoidance can increase rather than reduce allergy risk.
- Seat the infant upright and supervise continuously. Modify round, firm foods, quarter grapes lengthwise, cook hard vegetables, spread nut butter thinly and give no whole nuts under 5 years.
- Give no honey before 12 months, avoid unpasteurised foods and raw shellfish, limit salt and free sugar, and do not offer rice drinks under 5 years because of arsenic exposure.
- Use an open cup or free-flow cup from around 6 months and avoid juice, sweetened drinks and prolonged bottle use. Water can accompany meals once solids begin.
- A planned vegan diet needs reliable vitamin B12 plus review of iron, iodine, calcium, vitamin D, energy, protein and omega-3 sources with a paediatric dietitian.
- Responsive feeding means the adult chooses what, when and where; the child chooses whether and how much. Repeated calm exposure is preferable to force, distraction or reward.
Key red flags
Coughing, choking, wet breathing, colour change, recurrent chest infection or prolonged exhaustion with meals suggests dysphagia and aspiration.
Immediate urticaria, angioedema, wheeze, repetitive vomiting, floppiness or collapse after a food requires an allergy emergency plan and specialist assessment.
Bilious vomiting, haematemesis, blood in stool, severe abdominal distension or food impaction requires urgent medical assessment rather than dietary experimentation.
Weight faltering, dehydration, persistent diarrhoea, steatorrhoea or developmental regression suggests inadequate intake, malabsorption or systemic disease.
Loss of feeding skills, marked texture restriction, distress at the sight of food or meals regularly exceeding 30 minutes warrants multidisciplinary feeding assessment.
No reliable vitamin B12 source in a vegan infant or parent, or extreme food restriction imposed without replacement, creates urgent nutritional risk.
Investigation priorities
Confirm readiness, nutritional adequacy, texture safety and growth trajectory.
Management branches
The infant shows all three developmental readiness signs.
- Seat upright, offer a small amount when alert and continue usual breast milk or first infant formula.
- Include vegetables, an iron-rich food and safe finger foods while progressing texture.
- Follow cues, stop at satiety and repeat exposures without pressure.