Daycare and solid foods

Share your baby’s stage

The CDC tells child care providers that families are their partners: the parent decides when and how to start solids, and the provider supports that plan. That works best when you give them the details.

Before your baby starts, or when they start solids, tell staff:

• How your baby eats now: purées on a spoon, mashed food, finger foods, or a mix. See purées vs. baby-led weaning.
• Which foods they’ve already had, and which they haven’t. The CDC tells providers to check with a parent before giving a child a new food.
• How you serve key foods, such as soft finger-sized strips or small pieces no bigger than about 1 cm (just under ½ inch). Many US centers follow Caring for Our Children, which says to cut food for babies into pieces ¼ inch (about 6 mm) or smaller. The center will follow its own cutting rules, so ask what sizes they use and agree a plan (see “Where US and UK advice differs” below).
• Milk feeds: how much breast milk or formula, and roughly when.
• Their hunger and fullness signs. The CDC asks providers to feed responsively: offer the food, then let the child show when they’ve had enough. See hunger and fullness cues.

Update staff whenever something changes, like a new texture or a newly introduced allergen. A short note at drop-off is enough.

New allergens at home first. Offer foods like egg, peanut, fish or sesame for the first time at home, on a day your baby is well, when you can watch them for a couple of hours afterward. Once they’re a regular part of your baby’s diet, tell the provider they’re safe to serve. See how to introduce allergens.

If your child has a food allergy: a written plan

The CDC says children with food allergies should have a care plan created with their healthcare provider, covering their allergies, how to avoid the foods, and what to do in a reaction. Caring for Our Children, the national US child care standards from the AAP and the American Public Health Association, says the plan should be written and signed by the child’s doctor, and that staff should be trained to prevent, recognize and treat a reaction before they care for the child.

Your allergist or pediatrician can fill in a form such as FARE’s Food Allergy and Anaphylaxis Emergency Care Plan (formerly the Food Allergy Action Plan). It lists:

• the foods your child is allergic to
• the symptoms to watch for, mild and severe
• exactly what to do, including when to give epinephrine and what dose
• emergency contacts

Then make sure the provider:

• keeps the plan where staff can find it, and posts your child’s allergy and foods to avoid where every staff member can see them (CDC)
• has your child’s medicine on site, in date, with the instructions (CDC). If your child has been prescribed epinephrine, the usual advice is 2 doses: see signs of anaphylaxis
• takes the plan, a phone and the medicine on outings (Caring for Our Children)
• watches children at meals so they don’t share food (CDC)
• tells you straight away about any reaction (CDC, Caring for Our Children)

The CDC says the plan should be updated at least once a year. Ask your child’s doctor to check it sooner if the allergy or the dose changes.

In an allergic emergency

Every plan should say the same thing for a severe reaction: if your child has trouble breathing, wheezing, swelling of the lips, tongue or throat, turns pale or floppy, or has signs in more than one part of the body at once:

1. Give epinephrine first, if your child has been prescribed it.
2. Then call for an ambulance: call 911, even if your child seems better after the epinephrine.call 999 and say it’s anaphylaxis.call your local emergency number (such as 112 in Europe or 000 in Australia) and say it’s anaphylaxis.
3. Keep your child lying down, not standing or walking. Turn them on their side if they’re vomiting, and raise their head and shoulders a little if breathing is hard (NHS).
4. Call the parents once help is on the way.

Caring for Our Children says staff should call emergency services whenever they give epinephrine, even if the child seems to have recovered.

What to ask about choking-safe food and supervision

The AAP suggests asking providers about meals as part of choosing child care. Useful questions:

• Who watches the children eat? The CDC tells providers to sit within arm’s reach of babies under 12 months during meals, and at the same table as older children.
• Do children always sit to eat? The CDC says children should be seated, not lying down, walking or in a stroller. The AAP asks whether children are allowed to wander while snacking.
• How is food cut? Ask how they prepare round foods like grapes (quartered lengthwise), meat, cheese and cooked vegetables, and what sizes they use for babies and toddlers. The CDC tells providers not to serve children under 4 popcorn, spoonfuls of nut butter, whole grapes or cheese cubes. Caring for Our Children says not to offer children under 4 foods that may cause choking, such as hot dogs, popcorn, apples and grapes, so some centers don’t serve them at all.
• Are staff trained in child CPR and first aid? The AAP checklist asks about training for choking and allergic reactions.
• What happens after a choking incident? In England, settings record incidents that need first aid, like back blows, and tell parents (Department for Education).
• Can my child eat as much or as little as they want? The AAP suggests asking whether children are ever forced or bribed to eat.

For the full list of foods to prepare safely, see choking hazards and gagging vs. choking.

If your child is choking, staff should act straight away: shout for help, have another staff member call 911 at once, and start back blows straight away.shout for help and start back blows straight away, then chest thrusts for a baby under 1 or abdominal thrusts for a child over 1. If the blockage hasn’t cleared after one round of each, call 999 and keep going.shout for help, have another staff member call your local emergency number (such as 112 in Europe or 000 in Australia) at once, and start back blows straight away.

Labelling food and milk

Breast milk. The CDC tells providers to label each bottle with the child’s name and the date. Frozen milk should be labeled with the date it was expressed and the child’s name. Send small amounts, 2 to 4 oz (60 to 120 ml), to cut waste. Ask how they store it: breast milk can travel in an insulated cooler with frozen ice packs for up to 24 hours. The CDC tells providers to use milk left in a bottle within 2 hours after the baby stops feeding, or throw it away, to use thawed milk within 24 hours in the fridge (within 2 hours once warmed), and never to refreeze thawed milk.

Formula. Prepared formula should be used within 2 hours of making it and within 1 hour of starting the feed, and leftovers thrown away (CDC). Ask whether staff make bottles from your powder on site, and send the container labeled with your child’s name.

Food from home. Label each container with your child’s name, the date and what’s inside, and note how it should be served (for example, “warm, then cool; mash with a fork”). Pack it in an insulated bag with two cold sources, such as frozen gel packs, and ask staff to put it in the fridge when you arrive (USDA FSIS). Throw away any food left out at room temperature for more than 2 hours (1 hour if it’s hotter than 90°F / 32°C).

Where US and UK advice differs

• Allergy rules. In England, the Department for Education’s early years framework requires settings to get details of children’s dietary needs and allergies before they start, and to have one staff member at every meal check that each child’s food meets their needs and is prepared to prevent choking. In the US, Caring for Our Children sets national standards: a written plan signed by the child’s doctor for every child with a known allergy.
• First aid in the room. In England, a staff member with a full paediatric first aid certificate must be in the room when children eat. In the US, the AAP suggests asking whether all caregivers are trained in child CPR and first aid.
• Food sizes. Caring for Our Children says to cut food for infants into pieces ¼ inch (about 6 mm) or smaller and for toddlers ½ inch (about 1.3 cm) or smaller. That infant size is much smaller than the finger-sized strips this site describes at 6 months. The NHS shows finger-sized pieces for babies who feed themselves. The center will follow its own rules: ask which sizes your provider uses, and share how your baby eats at home.
• Nuts. US child care guidance groups high-risk foods up to age 4. In England, settings should not give whole nuts or whole seeds to children under 5.
• Anaphylaxis. In the UK, epinephrine is called adrenaline. The steps are the same: adrenaline first, then the ambulance call.