Starting solids with a premature baby

Start with your care team

If your baby was born early, ask your baby’s doctor, neonatal follow-up team, dietitian or health visitor when to start solids. The NHS says to ask your health visitor or GP, and the AAP suggests leaning on your baby’s NICU team for feeding support. The AAP notes that premature babies have special nutritional needs and may need time to develop feeding skills, so the right timing depends on your baby. If your baby has an individual feeding plan, for reflux, slow growth or feeding difficulties, follow that plan first (NHS).

This guide explains the general principles so you know what to ask.

Corrected age, explained

Your baby has two ages:

• Actual age: time since the day they were born.
• Corrected age: time since their due date. This is their actual age minus the number of weeks they were born early.

The AAP’s example: a baby born at 32 weeks was 8 weeks (2 months) early. At 4 months old, their corrected age is 2 months, and you’d expect the skills of a 2-month-old born at term. The AAP recommends using corrected age to judge development during the first 2 years.

For solids, NHS trust guidance for premature babies bases the timing on corrected age and readiness signs, not on date of birth (NHS Hounslow Healthier Together).

When to start

Readiness matters more than any date. NHS trust guidance for parents of premature babies gives these markers:

• Not much before 5 months corrected age. County Durham and Darlington NHS Foundation Trust says this is the youngest age a premature baby may show the cues they’re ready. Before then, they probably won’t have all the skills they need.
• Around 6 months corrected age, many babies are ready. If yours isn’t quite there, it’s fine to wait another week or two.
• Many premature babies are ready between 5 and 7 months corrected age, according to NHS Hounslow Healthier Together.

Guidance varies a little between NHS trusts: Cambridge University Hospitals says readiness usually comes around 4 to 6 months corrected age, and that babies born very or extremely early may need to start later. This is why the decision belongs with your baby’s own care team.

Readiness signs to look for

Cambridge University Hospitals suggests looking for three or four of these signs:

• sitting up with little or no support
• holding their head up easily and keeping it upright while sitting
• putting fingers, hands or toys in their mouth
• showing more interest when others are eating or when food is offered
• reaching for and holding food, or opening their mouth when food is offered
• biting and mouthing on toys

Whichever signs you see, your baby should be able to stay sitting upright (with support if needed) and hold their head steady before starting, so they can swallow safely (NHS). For the general signs every baby shows, see is my baby ready for solids?

Seating support

Premature babies are often smaller and may take longer to build the core strength to sit upright, so they may need extra support at first (Cambridge University Hospitals). Your baby should be upright, not leaning back or to one side. Cambridge University Hospitals says a rolled-up towel placed around the head can help keep it upright, and that specialist seats can give more support. Ask your team about seating if your baby slumps. Sitting upright makes eating safer and lowers the risk of choking.

First foods

Cambridge University Hospitals says premature babies often do well starting with smooth purées from a spoon, then moving on to soft finger foods once they’re developmentally ready, sitting upright and bringing things to their mouth.

Good first foods include:

• mashed or puréed soft-cooked vegetables like sweet potato, potato, carrot, butternut squash or broccoli
• mashed banana or avocado, thinned with your baby’s usual milk if needed
• smooth iron-fortified infant cereal or oatmeal mixed with breast milk or formula
• well-cooked, puréed meat like beef or chicken, or boneless fish like salmon
• well-cooked egg, mashed with your baby’s milk
• soft-cooked, mashed lentils or beans

Cook with no added salt or sugar, and no honey before 12 months. Start with a small amount, and go at your baby’s pace.

Moving on to lumps and textures

Once your baby is swallowing comfortably and eating about two meals a day, Cambridge University Hospitals suggests making purées thicker, then moving to food mashed with a fork. The trust notes that the bigger lumps in some stage 2 jars and pouches can be harder for premature babies to manage, and mashing them down helps.

Don’t put this off for too long without advice. The same trust says delaying solids or textures, unless your team advises it, can make it harder for your child to accept new foods and textures later.

Some gagging is normal while babies learn. If your baby keeps gagging on a texture and gets upset, the trust suggests leaving it a few days and trying again. Learn the difference between gagging and choking.

Iron and vitamins

The AAP says that for breastfed babies born prematurely, iron supplements may start in the first month after birth, and that once solids begin, babies also get iron from foods like meat and iron-fortified cereal. In the UK, Cambridge University Hospitals says babies born before 37 weeks are usually prescribed multivitamin drops until 6 months corrected age, and iron until 6 months actual age, and that all children from 6 months to 5 years should then have daily vitamins A, C and D. The AAP recommends 400 IU (10 mcg) of vitamin D a day for breastfed babies. Keep giving any supplements exactly as prescribed, and check with your team before stopping or switching. See iron-rich first foods.

Allergens and drinks

Cambridge University Hospitals advises introducing the common allergens, like egg, peanut (smooth peanut butter thinned into food, never whole nuts), cow’s milk in food, wheat and fish, as part of weaning, the same as for other babies, and not delaying them. The leaflet says “from six months” without saying whether that means actual or corrected age, so ask your team when to start. Don’t offer them before your baby is otherwise ready for solids, and don’t hold them back once solids are going well. If your baby has severe eczema or a suspected allergy, ask your team first. See introducing allergens.

Cambridge University Hospitals suggests offering a cup with sips of water from about 6 months corrected age. See cup and straw drinking.

When to ask for help

Contact your health visitor, pediatrician, dietitian or neonatal team if:

• your baby isn’t showing most readiness signs by about 6 months corrected age (Cambridge University Hospitals) or any by about 7 months corrected age (County Durham and Darlington NHS Foundation Trust)
• your baby struggles with feeding, gagging or swallowing (NHS)
• you’re worried about growth or weight gain (NHS)
• you’re unsure whether your baby is ready (NHS)

At developmental checks, the CDC suggests telling your doctor that your baby was born prematurely. In the US, your pediatrician or your baby’s NICU follow-up clinic is the place to start.In the UK, start with your health visitor, GP or neonatal team.Start with your baby’s doctor or child health nurse.

Where US and UK advice differs

• A corrected-age window. NHS trust guidance gives parents corrected-age markers: not much before 5 months corrected, many babies ready around 6 months corrected, and ask for advice if there are no signs by about 7 months corrected. The AAP’s parent pages don’t give a corrected-age number for starting solids. They recommend corrected age for judging development, the same readiness signs as for other babies, and support from your baby’s NICU team and pediatrician.
• Supplements. The AAP says breastfed premature babies may start iron in the first month. UK trust guidance, like Cambridge University Hospitals’, also describes routine prescribed vitamins for babies born before 37 weeks. Either way, follow what your baby’s team prescribes.

Ready? See what to feed at 6 months.