When Babies First Get Solid Foods: U.S. Timing, 2016–2018 (Corrected Report)

This page follows CDC's corrected report, republished in 2023. The original 2020 report put early introduction at nearly one in three infants; it was retracted after the National Survey of Children's Health disclosed a data processing error that had rounded reported ages for breastfeeding, first formula and first solid foods down by a month in most cases. After the authors reanalyzed the corrected data, the results and conclusions changed.

Complementary foods are any solid or liquid other than breast milk or infant formula. The American Academy of Pediatrics (AAP) recommends starting them at about 6 months. Experts don't fully agree on the ideal time, but most agree that before 4 months is too early, because an infant's digestive system and motor skills are not ready. Starting early also keeps exclusively breastfed babies from reaching the recommended 6 months of exclusive breastfeeding, and may be linked to a higher risk of overweight and obesity.

The data

CDC analyzed the 2016–2018 National Survey of Children's Health, a web and paper survey of parents and caregivers run by the Health Resources and Services Administration's Maternal and Child Health Bureau. Parents of children aged 1–5 were asked how old the child was when first fed anything other than breast milk or formula. Answers after 12 months, and feeding histories that left a child with no source of nutrition for 2 months or more, were excluded, leaving 23,743 children. It was the first time state-level estimates had been available.

When foods were introduced

The average age at first complementary food was 5.7 months:

• before 4 months (early): 15.6%;
• 4–6 months: 63.3%;
• 7–12 months: 21.1%.

Another national survey, NHANES 2009–2014, found a similar share introduced early (16.3%) and similar patterns across groups. That most infants are not fed early may suggest parents, caregivers and providers have taken the recommendations to heart.

Who starts early

The rate among Black children was significantly higher than in every other group. By region it ranged from 11.6% in the West to 17.8% in the South, and by state from 7.6% in New Mexico to 34.4% in Mississippi. In 23 states the share was above the national figure, and in four it was at least 20%.

Why timing matters

Many mothers who start early say they believed their baby was old enough — suggesting babies are sometimes thought ready before they are, and that parents may not know the recommendations, the health effects or the signs of readiness. Babies are usually ready at about 4–6 months, when they can:

• sit up on their own with good head control;
• show interest in mealtimes;
• are hungry between feedings;
• no longer push food out with their tongue (the "tongue-thrust" or extrusion reflex).

Younger infants lack the development to eat these foods safely and face higher risk of several health problems. Compared with 6 months of exclusive breastfeeding, 3–4 months followed by mixed feeding is linked to more gastrointestinal infections in babies and slower weight loss for mothers after birth.

What helps

Health care providers can give consistent advice in line with AAP recommendations and stress developmental readiness. Because early introduction is more common among formula-fed babies, education aimed at their parents and caregivers may help most. Peer educators, early care and education staff, and WIC staff can reinforce the same message.

Limitations

About 7.4% of parents reported exactly 12 months, far more than 11 or 13 months, which may reflect rounding; excluding those answers raised the early-introduction figure by 1.2 percentage points. Parents' memory of when solids started may be less reliable than of breastfeeding. Income data may be misclassified, the survey didn't cover types or amounts of food, and state samples were too small for deeper analysis.

Sources

• Chiang KV, Hamner HC, Li R, Perrine CG. "Timing of Introduction of Complementary Foods — United States, 2016–2018," MMWR, November 27, 2020, as retracted and republished by CDC in July 2023 (PMC13183349), with the retraction notice (PMC10390084). An Expression of Concern preceded the retraction in June 2023. The figures here are from the corrected report; the original report's charts are not reproduced.